Please see the webinar invitation for TennCare Pharmacies, during which OptumRx will unveil the findings from the Pharmacy TennCare Cost of Dispensing Survey. During this event, OptumRx will also disclose the updated professional fees applicable to all pharmacies within the TennCare Pharmacy Network. Please do not hesitate to reach out to your Provider Liaison Pharmacist with questions or concerns at TNRxEducation@optum.com.  

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

Gov. Bill Lee (R), Department of Economic and Community Development Commissioner Stuart C. McWhorter, and The Kroger Company officials announced that Kroger will be constructing its fifth U.S. Central Fill facility in Cleveland, TN. Rep. Kevin Raper (R-Cleveland) stated, “…This endeavor will create 140 jobs and provide state-of-the-art care through the utilization of automated technology to fulfill prescriptions. We are honored to be the site for this project, and highly anticipate the positive impact it will have on our economy and community.” 

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

Gov. Bill Lee (R), Department of Economic and Community Development Commissioner Stuart C. McWhorte, and The Kroger Company officials announced that Kroger will be constructing its fifth U.S. Central Fill facility in Cleveland, TN. Rep. Kevin Raper (R-Cleveland) stated, “…This endeavor will create 140 jobs and provide state-of-the-art care through the utilization of automated technology to fulfill prescriptions. We are honored to be the site for this project, and highly anticipate the positive impact it will have on our economy and community.” 

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

The new rule from Tennessee Department of Commerce and Insurance, 0780-01-95 – Pharmacy Benefits Managers, became effective June 27, 2023. 

Also in Tennessee, beginning August 1, 2023, prior authorization requirements will be removed for the following preferred medications: Advair Diskus, Advair HFA, Dulera, Symbicort, aripiprazole, Diclegis, ezetimibe, fenofibrate and Xarelto. We encourage you to read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) should you have additional questions. 

Finally, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL [Preferred Drug List] may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now 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 read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) or tnrxeducation@optum.com should you have additional questions. For more details on Clinical Criteria, please visit https://www.optumrx.com/oe_tenncare/landing. 

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

The Division of TennCare and its Managed Care Contractors (MCCs) would like to inform you of changes to the buprenorphine prescription benefit for TennCare members. These system and procedural changes impact prior authorization requirements for providers who prescribe buprenorphine products to TennCare members and those providers who participate in the Buprenorphine Enhanced Supportive Medication Assisted Recovery and Treatment (BESMART) provider network. These coverage allowances and changes to prior authorization processes became effective on May 15, 2023. 

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 PDL (preferred drug list) may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now 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 contact OptumRx’s Pharmacy Support Center (866-434-5520) or tnrxeducation@optum.com should you have additional questions. For more details on Clinical Criteria, please visit the website.

Also in Tennessee, the Tennessee Pharmacists Research and Education Foundation is looking to partner with 10 additional pharmacies for the Community Outreach Immunization Initiative. This opportunity is open to pharmacies across Tennessee that are willing to engage patients that have not received their COVID-19 vaccination series, as well as any other patients who may have gaps in their vaccination history. This opportunity will be a nine (9) month commitment and could earn your pharmacy up to $31,500. If you are interested register at the link here. If you have further questions about this opportunity, reach out to Danielle McCoy. 

Finally in Tennessee, this communiqué has been sent to provide further clarification on the buprenorphine update changes that became effective May 15, 2023. Additionally, you will find an updated memo that properly reflects the recent buprenorphine changes for your records.  

We encourage you to review this information thoroughly and contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com should you have questions.  

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

To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. 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). We encourage you to review this information thoroughly and contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com should you have questions. 

Also in Tennessee, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now 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 read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) or tnrxeducation@optum.com should you have additional questions. For more details on Clinical Criteria, please visit https://www.optumrx.com/oe_tenncare/landing. 

Finally in Tennessee, effective July 1, 2023, TennCare members will be able to obtain Continuous Glucose Monitors (CGMs) and supplies from their local in network retail pharmacy. This new coverage pathway will not affect coverage under the medical plan. This update allows TennCare members to access CGMs and related supplies through either their pharmacy OR medical program. Under this new coverage pathway, prescriptions for CGMs and maintenance supplies may be sent to your patient’s in-network pharmacy of choice. We encourage you to read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) or tnrxeducation@optum.com should you have additional questions.

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

The Department of Commerce and Insurance (TDCI) has launched a new, updated website. This website has direct links to the Standard Pharmacy Reimbursement Appeal Form and the formal Pharmacy Benefit Manager Complaint Form. The complaint form is fully electronic now to add ease of use on pharmacies and patients to submit complaints to TDCI. 
 
Also in Tennessee, please see the provider notice regarding Sedative Hypnotic Benefit Limits. We encourage you to review this information and contact the OptumRx Provider Liaisons at tnrxeducation@optumrx.com with any further questions.

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

PBM Enforcement Update with TDCI (Tennessee Department of Commerce & Insurance). TPA welcomes Jud Jones, PharmD, Manager of PBM Compliance at TDCI on  May 17 from 12:00 noon-12:30 p.m. CT and 7:00 p.m.-8:00 p.m. CT to hear the latest on PBM enforcement in the state.

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