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.

The Board of Pharmacy met on May 7 and provided several key regulatory insights:  

• BOP CE (Continuing Education) Violations Policy has been updated on the website and will be effective July 1, 2024. The new policy clarifies disciplinary action procedures, including signing an Agreed Citation if found to be in violation of the policy. 
• BOP has granted its Executive Director the authority to issue waivers for the rule requiring out-of-state pharmacists to be licensed for 12 months before being eligible for a state license. 
• Licensing fees will increase across the board as the BOP works to resolve its budget. 
• BOP will use the NABP form for conducting GAP analysis during compounding facility inspections. The updated form will be under “Applications” on the BOP website. 
• BOP Town Hall on compounding rules will be August 21. A virtual meeting link will be created, and the public can also attend in-person at 665 Mainstream Drive in Nashville. 

The next BOP Rules Review meeting will be held on June 13 from 10:00 am to 2:00 pm CT. 

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

TennCare distributed an updated Preferred Drug List (PDL) effective May 1. Subscribe to the TennCare Pharmacy Updates newsletter to receive updates directly from TennCare. 

Also in Tennessee, on May 1, Gov. Bill Lee (R) signed SB 869/HB 282 into law. This legislation, which takes effect immediately, will improve efficiencies in the health care system by providing pharmacists with independent prescriptive authority for various medication classes and disease states. The Tennessee Pharmacy Association is developing additional resources and education to assist pharmacists that want to implement this law into their practice settings. 

Finally in Tennessee, the Department of Health will host three free in-person sessions for its Injectable Drug Diversion Workshop for pharmacists at the following times and locations: June 20 in Nashville, July 12 in Jackson, and July 22 in Knoxville. Learn more and RSVP! 

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