Please see the updates to the PDL, Clinical Criteria, and Interim Criteria below for April 2022. These changes went into effect on April 1^st.

• BaG additions: Combigan
• Added to preferred: naloxone, Valtoco, glycopyrrolate solution, Myfembree
• Added to non-preferred: Dartisla ODT, Eprontia, Xarelto suspension, Xenleta, Brexafemme, nitazoxanide, Elepsia XR, Azstarys, adapalene/benzoyl peroxide, carglumic acid, Zokinvy, Palforzia, Lumakras, Tepmetko, Qinlock, bimonidine/timolol, Bronchitol
• Added to interim: Recorlev, Tarpeyo, Livmarli, Trudhesa, Tyrvaya, Skytrofa, Besremi, Tavneos, Adbry, Livtencity
• Modified criteria/quantity limits for Adderall, Adderall XR, Adefovir, Adhansia XR, Adzenys ER solution, Adzenys XR ODT, amphetamine ER suspension, Ancobon, Arikayce, Baraclude solution, clonidine ER, Cotempla XR ODT, Cresemba, Daytrana, Desoxyn, Dexedrine spansule, dexmethylphenidate XR, dextroamphetamine soln, Dificid tablet and suspension, doxycycline hyclate 20mg, Dyanavel XR, Evekeo tab & ODT, flucytosine tablets, Focalin, Fuzeon, Hepsera, Intuniv, Isentress HD, itraconazole, Jornay PM, ketoconazole, linezolid suspension, Lumakras, methamphetamine, Methylin solution, methylphenidate chewable, methylphenidate ER, methylphenidate SA OSM, methylphenidate XR ODT, Mycobutin, Mydayis ER, Nuzyra, Oravig, Pegasys syringes, Pegasys vials, Qelbree, Qinlock, Quillichew ER, Quillivant XR, Relexxii, Ritalin, Ritalin LA, Sporanox, terbinafine tablets, Tybost, Vemlidy, Xenleta, Zenzedi, Zyvox suspension, Zyvox tablets.

Additionally, these documents can be found on the TennCare website.

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

Notice from TennCare, 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). Note: A list of the preferred agents and the clinical criteria can be found here.

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

Renee Williams-Clark has left TennCare as Chief Pharmacy Officer. Lorraine Buerhaus has been named interim CPO. Pharmacists interested in applying for this position can do so here.  

Also in Tennessee, The Institute for Safe Medication Practices (ISMP) will present its free online seminar, “Diversion is a Threat to Patient Safety: Adopting Best Practices for Safe Management of Controlled Substances,“ on April 6, 1-2 pm ET. 

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

Please see the updates to PDL, Clinical Criteria, and Interim Criteria below and the attached documents for March 2022. These changes went into effect on March 1st.  

• Added to preferred: dimethyl fumarate, Dexilant, SPS, 
• Added to non-preferred: Tecfidera, Tecfidera starter pack, dexlansoprazole, Dhivy, ciprofloxacin/dexamethasone, Epclusa pellet, Mavyret pellet
• Added to interim: Rezurock, Vuity, Voxzogo,  
• BaG additions: Dexilant 
• BaG removals: Tecfidera, Tecfidera starter pack 
• Hepatic C Direct Acting Antivirals prior authorization criteria and PA forms: removal of restrictions surrounding prior history of substance or alcohol abuse, where applicable, removed questions related to pregnancy, concomitant ribavirin use, and renal function dosage adjustments.  

Additionally, these documents can be found on the TennCare website: www.optumrx.com/tenncare  

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

The Department of Health has provided an update on COVID-19 oral antiviral therapeutics in the state, specifically, Paxlovid® by Pfizer and Molnupiravir by Merck, with guidance for pharmacies requesting them.

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

The Department of Health held a COVID-19 Provider online seminar on February 11, 2022 and discussed availability of certain therapeutics in the state. A recording and slides from the online seminar have been posted online.

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

The Tennessee Department of Health is expanding access to COVID-19 vaccine with a particular focus on rural and underserved areas. TDH (Tennessee Department of Health) is partnering with pharmacies and community health clinics to add more than 100 new vaccination sites across the state.

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

Effective January 15, 2022, to broaden access to SARS-CoV-2 at-home testing, the Division of TennCare began coverage of rapid at-home tests with Emergency Use Authorization (EUA) through the OptumRx Pharmacy Point of Sale System.  

For further questions, please contact OptumRx Provider Liaisons at tnrxeducation@optum.com  

Also in Tennessee, please see updates to the TennCare Preferred Drug List, Clinical Criteria, TennCare Branded Drugs to be Classified as Generics and Interim Criteria below for February 2022. These changes went into effect on February 1st.  

• Added to preferred: molnupiravir, Paxlovid 
• Added to non-preferred: sertraline capsules 
• Added to interim: Bylvay, Qulipta, Scemblix, Invega Hafyera, Lybalvi 
• BaG removals: Xopenex, Uloric 

Finally in Tennessee, Lucy A. Shell, PharmD, TPA’s Director of Pharmacy Practice Initiatives and former Interim Executive Director, was named Executive Director for the Tennessee Board of Pharmacy, effective Feb. 21.

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

Applications for TPA executive officers, society leaders, and committee members are being accepted through Dec. 15. Volunteer or nominate a colleague to serve.

Also in Tennessee, the Tennessee Department of Health (TDH) is required by the Centers for Disease Control and Prevention (CDC) to audit providers of COVID-19 vaccines. The Tennessee Pharmacists Association requested a checklist for those who have been selected for an audit, and one was prepared by TDH. Please review the checklist and the Routine and Emergency Vaccine Management Plan in their entirety.

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