TennCare has made several changes to the Preferred Drug List (PDL) effective October 1, as they continue the process of reviewing all covered drug classes.

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

Please see the Provider Notice that updates to TennCare Preferred Drug List, Clinical Criteria, and Interim Criteria below for October 2021.  These changes go into effect on October 1^st.

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

Public Chapter 569 went into effect on July 1, 2021. To assist with the implementation process, especially regarding the filing of PBM complaints with the Tennessee Department of Commerce and Insurance (TDCI), the Tennessee Pharmacy Association has worked with TDCI to troubleshoot the complaint process and has been working to develop materials to guide pharmacies as they submit formal PBM complaints.  TPA will be conducting several 30-minute open-forum webinars to share the latest news and information related to implementation of Public Chapter 569. These webinars will allow members to hear from TPA staff and other stakeholders, as well as serve as an opportunity to hear from you about the resources you still need. 

Also in Tennessee, the Tennessee Board of Pharmacy, at the September meeting, determined that, for purposes of pharmacist-to-technician waivers, certified technicians could be those trained by an ACPE-approved program outlined in a PREP Amendment. The BOP will discuss USP standards at its November 16-17 meeting. 

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

The Tennessee Pharmacy Association has produced a flowchart to help guide pharmacists through the process of filing complaints when PBMs are not following the new law. This flowchart was developed after hearing from the Tennessee Department of Commerce and Insurance (TDCI) that they are receiving incomplete claims, claims that still need to go through the MAC Appeal Process, or claims for Medicare, over which TDCI has no jurisdiction. This will be the first in a series of educational materials that TPA will provide in the coming weeks.

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

A proposed rule of the Department of Mental Health and Substance Abuse Services would repeal and readopt regulations under RRT 0940-06-01 to update standards on controlled substances. The rule would include the schedules of controlled substances and lists of certain non-narcotic substances, chemical preparations, prescription products, anabolic steroids and cannabis products that are excluded from the schedules. A hearing is scheduled for August 2, 2021, in Nashville. Comments are due August 12, 2021.

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

SB 982 was signed by Governor Bill Lee (R) on May 25, 2021, and removes pharmacies from oversight of the Tennessee Medical Laboratory Board and makes the state list of CLIA waived tests the same as the federal CLIA waived tests, easing previous restrictions on Tennessee pharmacies holding an active CLIA waiver.

Also in Tennessee, HB 1398 which establishes PBM standards around 340B discrimination, prohibits patient steering, prevents spread pricing and below-cost reimbursement as well as a provision, which goes into effect January 1, 2022, that requires a PBM or other health care payer, upon request of an enrollee, health care provider, or authorized third party, to furnish the cost, benefit, and coverage data of a health care plan. The bill was signed by Governor Bill Lee (R) on May 26, 2021, and (unless otherwise indicated) will take effect on July 1, 2021.

Lastly in Tennessee, the Department of Health published a proposed rule to amend, adopt, and repeal regulations under RRT 1140-11 and 1145-01 to require dispensing health care practitioners or their agents to submit specified data to the Controlled Substance Database. The rule also would not require the reporting of Schedule V controlled substances that can be dispensed without a prescription. A hearing is scheduled for August 4, 2021, in Nashville.

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

TennCare has released a new provider notice regarding COVID-19 vaccine pharmacy claims. This notice contains two important updates. One includes the addition of Johnson & Johnson vaccines and the single-dose administration payment. The other update involves a newly established Collaborative Pharmacy Practice Agreement (CPPA) to order and administer COVID-19 vaccines for the State’s TennCare population, which includes CoverKids and CoverRx.

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