TennCare announced the list of covered UPCs for its upcoming diaper program. Luvs, Pampers, Huggies and Cuties are the primary brands that will be covered. If your pharmacy plans to participate and wants to be featured on the TennCare website as a participating location, complete this survey.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
TennCare announced the list of covered UPCs for its upcoming diaper program. Luvs, Pampers, Huggies and Cuties are the primary brands that will be covered. If your pharmacy plans to participate and wants to be featured on the TennCare website as a participating location, complete this survey.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
TennCare Diaper Program website now includes a billing guide, optional diaper request form and survey link for pharmacies to be included on the list of providers that will be available for TennCare and CoverKids members.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
CVS Caremark will contact low-volume pharmacies and pharmacy services administrative organizations (PSAOs) this month with information regarding its re-billing and re-processing updates to comply with 2022’s Public Chapter 1070 for claims from January-October 2023. Due to the switch from AWP to NADAC pricing, some pharmacies may need to pay recoupment fees to CVS Caremark. The Tennessee Pharmacy Association has been in contact with CVS Caremark representatives and legislative leadership and is working to communicate with PSAOs about this change and next steps pharmacies can take to prevent financial losses. Pharmacies should submit rate review requests to CVS Caremark before submitting external appeals to the Department of Commerce and Insurance to rectify this situation.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The TennCare pharmacy diaper program will launch on August 1, 2024. For children ages two years and younger, the program provides access to up to 100 diapers per month per child. Children with TennCare or CoverKids are eligible. Pharmacies can voluntarily participate as access points for the program; an informational webinar for pharmacies will be held on July 9 from 9:00-10:00 am CT.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
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 the lists of the preferred agents and the clinical criteria and see the list of Tennessee OptumRx Provider Liaisons.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
This notice is being sent 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.
Despite strong opposition from employer groups and insurance brokers speaking out against any PBM enforcement, new proposed rules by the Department of Commerce and Insurance which will enact Public Chapter 998 and allow Tennessee Department of Commerce and Insurance to audit PBMs were approved by the Government Operations joint committee and will take effect on June 25, 2024. Thank you to Tennessee Pharmacy Association (TPA) CEO Anthony Pudlo, who testified before the Joint Government Operations Committee in support of these rules.
Also in Tennessee, if you would you like to serve on TPA’s new Specialty Pharmacy Committee, please complete this form to express your interest. The Committee Chair will make committee appointments in the coming weeks, so please respond soon.
Finally in Tennessee, TPA is looking for Champion Advocates across the state to build relationships with their elected officials and help identify physicians who may advocate for the pharmacy profession. Sign up to become a TPA Champion Advocate!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
On May 17, CMS approved Tennessee’s request to amend its Medicaid section 1115 demonstration, “TennCare III.” This amendment significantly changes its coverage and benefits, including eligibility for parents and caretaker relatives, introducing a new benefit to cover diapers for infants under the pharmacy benefit, enhancing home and community-based services (HCBS) focusing on employment supports and more. The Tennessee Pharmacy Association will work closely with TennCare leadership as the diaper program logistics are finalized.
Also in Tennessee, the Tennessee Pharmacists Association invites pharmacy teams to learn about the Department of Health (TDH) Health Trailblazers Initiative, a program aimed at enhancing the well-being of adult and perinatal populations by fostering vaccine confidence in clinical settings. This initiative seeks to build a collaborative network of healthcare providers dedicated to improving immunization practices and outcomes. Register now to join an informational session on May 28 from 12:00 pm – 12:30 pm CT.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.