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.

During the July Board of Pharmacy meeting, the Office of the General Counsel announced that the new pharmacy technician rules are expected to take effect around October 21. Additionally, a rulemaking hearing on compounding regulations is anticipated to be scheduled later this year or early next year. The Board’s October meeting has been rescheduled to October 20 and 21.

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

Effective August 1, TennCare will no longer enforce the five prescription limit per month on prescription drugs and refills for adult TennCare enrollees; however, the two brand prescription limit per month will remain in effect. Members may exceed the two brand monthly prescription limit by utilizing the products on the Auto-Exempt and Attestation List. As a reminder, the limit starts over at the first of each month. No changes will be made to the CoverRx and CoverKids programs. TennCare Pharmacy Updates are available online.

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

Last week, Gov. Bill Lee (R) announced that Ralph Alvarado has stepped down as state’s Commissioner of Health (TDH), effective July 11. The current state epidemiologist, John Dunn, will serve as interim commissioner. 

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