The Department of Health recently released a “Dear Colleague” provider communication highlighting recent changes to the hepatitis B vaccine recommendations. Specifically, this communication emphasizes the severity of hepatitis B infection for infants and adolescents, as well as how hepatitis B often goes undiagnosed, which leads to a delay in treatment.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
This notice is to inform you of changes to the TennCare pharmacy program. We encourage you to read this thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) should you have additional questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
TennCare has made updates to Obesity and Oncology drug management. GLP-1 prior authorizations will remain active for one year with no changes to the criteria for approval as of December 1, 2025. Initial claims for oncology products will no longer be for 14-days’ supply, but instead subject to plan limitations, quantity limits and prior authorization criteria taking effect January 1, 2026. For comprehensive, clinical criteria, please visit the TennCare/Optum Rx® website and scroll to find “PDL Criteria” under “Useful Links”.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
TennCare is continuing the process of reviewing all covered drug classes. Changes to the Preferred Drug List (PDL) occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. We encourage you to share this information with other TennCare providers. The individual changes to the PDL are listed below. The new PDL will be posted on January 1, 2026. For details on clinical criteria, please visit OptumRx/TennCare and click on “Criteria PDL” under “Useful Links”.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The deadline to submit an attestation of low-volume status and proof of actual prescription volume to your contracted PBMs is December 1. Volume status is based on your pharmacy’s actual prescription volume from July 1, 2024, to June 30, 2025. For more information, please refer to the Department of Commerce and Insurance (TDCI) rules. The Tennessee Pharmacists Association’s PBM resource page also has some helpful information to assist you with this process.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Pharmacy rules related to certified pharmacy technician administered immunizations and point-of-care tests are now effective. Please see rule 1140-02-.02.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Certification of low-volume status must be submitted to each PBM you work with by December 1 annually to ensure you receive the low-volume dispensing fee. The Department of Commerce & Insurance (TDCI) rules 0780-01-95-.01(1) outlines requirements for submitting such certifications, including submitting proof of the pharmacy’s actual prescription volume from July 1, 2024 to June 30, 2025.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Effective October 1, TennCare will cover OTC medications and supplements at a GPI (generic product identifier) level rather than by specific NDCs. Please review this document for additional information and instructions on how to dispense such products.
Also in Tennessee, TennCare distributed an updated Preferred Drug List (PDL) that was effective on September 1. Additional TennCare updates are available online. Subscribe to the TennCare Pharmacy Updates newsletter to receive updates directly from TennCare.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Tennessee Pharmacists Association (TPA), National Community Pharmacists Association (NCPA) and American Pharmacists Association (APhA) jointly filed an amicus brief in federal court supporting Tennessee’s 2021 law regulating PBMs. The law, aimed at protecting patient choice and pharmacy access, bans PBMs from practices like patient steering and excluding pharmacies from preferred networks. The case stems from a challenge by McKee Foods arguing that the law is preempted by the federal ERISA statute.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
