TennCare released a document summarizing the temporary changes in counties impacted by Hurricane Helene, aligning with Gov. Bill Lee’s (R) Executive Order No. 105. These changes aim to provide relief to victims of severe weather and flooding and will remain in effect until December 25, 2024.

Also in Tennessee, all pharmacies participating with TennCare and OptumRx are encouraged to contact their provider liaison for any processing issues or questions.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

TennCare released a document summarizing the temporary changes effective September 27, 2024, in counties impacted by Hurricane Helene, aligning with Gov. Bill Lee’s (R) Executive Order No. 105. These changes aim to provide relief to victims of severe weather and flooding and will remain in effect until December 25.

Also in Tennessee, TennCare has made numerous changes to the TennCare Pharmacy Program. Please visit the Optum landing page for these updates. For more information, contact OptumRx’s Pharmacy Support Center at 866-434-5520.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Division of TennCare issued Provider_Notice_Contraceptives_11.05.24.pdf. Effective January 1, 2025, in response to the amended Tennessee Code Annotated (TCA), Title 56, Chapter 7, Part 23 (Public Chapter No. 732), TennCare and CoverKids members are eligible to receive up to a 12-month supply of self-administered hormonal contraceptives (e.g., oral, topical and vaginal) in a single dispensing. A smaller quantity may be provided if requested by the member or if specified by the healthcare provider.

This legislation does not apply to contraceptives administered by a healthcare provider, such as intrauterine devices, implants and injectable contraceptives.

For TennCare members, please refer to the TennCare-PDL (Preferred Drug List) (optumrx.com) for a list of preferred contraceptives. Non-preferred contraceptives still require prior authorization (PA) approval before a single 12-month supply can be dispensed.

For CoverKids members, please refer to CoverKids Select Standard Formulary (optumrx.com) for a list of covered contraceptives.

All standard point-of-sale edits (e.g., quantity limits, refill too soon, duplicate therapy, etc.) associated with contraceptives will remain in place.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

In accordance with the Tennessee Department of Commerce and Insurance, Division of Insurance Rule 0780-01-95-.10(1)(b) and 0780-01-95-.10(2)(b), the deadline to submit an attestation of low-volume status and proof of actual prescription volume to your contracted PBMs is December 1, 2024. Volume status is based on your pharmacy’s actual prescription volume from July 1, 2023, to June 30, 2024.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

According to the Department of Commerce and Insurance (TDCI) Rule 0780-01-95-.10(1)(b) and 0780-01-95-.10(2)(b), the deadline to submit an attestation of low-volume status and proof of actual prescription volume to your contracted PBMs is December 1, 2024. Volume status is based on your pharmacy’s actual prescription volume from July 1, 2023, to June 30, 2024.  

Also in Tennessee, the Tennessee Pharmacy Association (TPA) is hosting a Pharmacy Technician Conference on November 16 from 9:00 am to 4:15 pm. Pharmacy technicians are invited to register at one of four locations across Tennessee to advance their careers, earn continuing education (CE) credit (including pharmacy law and patient safety) and develop valuable connections. 

Finally, register for the TPA and the Tennessee Pharmacists Consortium for Education’s (TPCE’s) training program, the PBM Playbook: Mastering MAC Appeals in TN. The three-session training program will be presented by Tyler Dougherty, an esteemed expert in PBM reform and compliance. The sessions are on November 6, November 20 and December 4. Please register in advance.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Department of Health’s Vaccine-Preventable Diseases and Immunization Program (VPDIP) released “Recommendations for Vaccination After a Flood” addressing recommended vaccinations following flooding events. It includes updated vaccinations for tetanus, hepatitis A, hepatitis B, flu and COVID-19 as well as vaccines for cholera and typhoid.

Also in Tennessee, Blue Cross Blue Shield of Tennessee released its proposed 2025 essential and preferred formulary changes. Removals include Victoza, Humira, brand name Vyvanse and many more. The formulary changes also include new additions, tier modifications, quantity limit additions/removals and new prior authorizations.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Bill Lee (R) issued an executive order allowing pharmacist to dispense a 30-day supply of medication (excluding controlled substances) without prior authorization for victims of Hurricane Helene. This order remains in effect until November 10. The Tennessee Pharmacy Association has compiled a list of resources and ways to support the impacted communities as relief efforts continue. Recent Department of Commerce and Insurance (TDCI) Bulletin 24-03 also provides for one early or replacement prescription refill per medication; see last bullet on page 2.

Also in Tennessee, the Tennessee Pharmacy Association requests your participation in the TennCare Diaper Program Survey. The feedback will provide data that will be shared directly with TennCare pharmacy leadership addressing reimbursement rates, administrative fees, successes and difficulties that pharmacy professionals have experienced since the diaper program launch.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective October 1, 2024, over the Counter (OTC) COVID-19 testing kits will no longer be covered under TennCare’s pharmacy benefit due to the end of the COVID-19 Public Health Emergency. Beginning October 1, 2024, Covid Test Kits will remain a covered benefit under the medical benefit.

Effective September 1, 2024, TennCare began reimbursing pharmacy providers through the OptumRx Pharmacy Point of Sale System (POS) for the administration of newly FDA approved COVID-19 vaccines for the 2024-2025 Formulas. Per FDA guidance, previous versions of COVID-19 vaccines are no longer recommended or authorized for use. CoverKids and CoverRx claims also follow this FDA guidance.

Claims for COVID-19 vaccines are exempt from co-pays and script limits for all TennCare enrollees.

COVID vaccine claims for dual eligible members (Both Medicare and Medicaid eligible) will receive NCPDP Reject 65 “Patient has Medicare Coverage, Bill Medicare.”

Please note for TennCare members, effective October 1, 2024, the Covid-19 vaccine reimbursement will change to include only the cost of the vaccine plus the Professional Dispensing Fee (PDF). The $40 administration fee will be discontinued. Therefore, the Incentive Amount Submitted (NCPDP Field 483-E3) is no longer required for claim submission. If you have a TennCare Medicaid ID, you may contract with the individual Managed Care Organization(s) to bill for ancillary services. Please contact the designated health plan Provider Services for assistance.

Also in Tennessee, prior authorization requirements can be bypassed for certain medications when specific medical conditions exist. The submitted claim should include a Diagnosis Code Qualifier (Field # 492- WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). See a list of the preferred agents and the clinical criteria here, and see the list of Tennessee OptumRx Provider Liaisons here.

Finally in Tennessee, the Tennessee Pharmacists Research and Education Foundation (TPREF) is proud to offer an ACPE-accredited OSHA training webinar that meets all of OSHA’s annual training requirements, with ten sessions offered between September 25 and October 23. Register for one of the sessions!

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

During the most recent Board of Pharmacy meeting, the Board confirmed that rules for technician immunizations will not be finalized before the PREP Act expires. However, technicians should still be able to vaccinate after receiving a waiver from the Board’s Executive Director Lucy Shell. NACDS and Tennessee Pharmacy Association are working to confirm details of this process and will share more information as it becomes available.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.