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.

TennCare has contracted with Mercer Government Human Services Consulting to conduct a professional cost of dispensing survey and a survey of acquisition cost data. Both surveys will begin on April 3 and must be submitted to Mercer no later than May 12. All network pharmacies will be required to complete the professional cost of dispensing survey; however, only select pharmacies will also be required to complete the biannual AAAC (Average Actual Acquisition Cost) survey. Please direct questions regarding the survey to Lora.Underwood@tn.gov or mercerrxpassage@mercer.com.

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

TennCare has contracted with Mercer Government Human Services Consulting to conduct a professional cost of dispensing survey and a survey of acquisition cost data. Both surveys will begin on April 3. Mercer will conduct a technical online seminar on March 20 at 10am CT to discuss both surveys and answer provider questions. Join the online seminar at this link with passcode 030511.

Also in Tennessee, the recent TennCare issue regarding AAAC rate updates has been resolved. Please review this document and contact tenncare_inquiry@optum.com with any questions.

Finally, to help TennCare prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses are on the Appropriate Diagnosis for PA Bypass document. 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 also be found at www.optumrx.com/oe_tenncare/landing.

Please contact OptumRx Provider Liaison Ginger Stoves (ginger.stoves@optum.com) if you have additional questions. Ginger is the primary contact for Middle Tennessee, and the temporary primary contact for East and West Tennessee.

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

TennCare has contracted with Mercer Government Human Services Consulting (Mercer) to conduct a professional cost of dispensing survey and a survey of acquisition cost data, also known as the Average Actual Acquisition Cost (AAAC) survey. Both surveys will begin on April 3, 2023, and must be submitted to Mercer no later than May 12, 2023. 

All network pharmacies will be required to complete the professional cost of dispensing survey; however, only select pharmacies will also be required to complete the biannual AAAC survey.  

Mercer will conduct a technical online seminar on March 20, 2023, at 10:00 AM CST to discuss both surveys and answer any provider questions. Please utilize the log in information below to join:   

Link:   https://mmc.zoom.us/s/92516957090?pwd=S0p3bm9JeHFGRTJ4R2NOeTZMNitnUT09 

Passcode: 030511  

Please feel free to direct any questions regarding the survey to (Lora.Underwood@tn.gov) or mercerrxpassage@mercer.com.  

Also in Tennessee, please view the pharmacy provider notification regarding missing AAAC rates. You can contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com if you have any questions.  

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

TennCare is now in Phase II of its plan to unwind from the Public Health Emergency. They have created a communications toolkit and offered several other resources that healthcare providers, including pharmacies, can use to share more information with TennCare patients to ensure their coverage does not fall through. 

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

TPA [Tennessee Pharmacists Association] will offer Mental Health First Aid training to 25 attendees at the TPA Winter Meeting, held in Nashville on February 26–27. Space is limited. Register Today! 

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

Tennessee Justice Center will be hosting a webinar on March 1, at 11:00 am (Central) focused on how to prepare your team for having conversations with TennCare beneficiaries about their eligibility redetermination.

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

The Division of TennCare invites you to our virtual Annual Feedback Session for the Episodes of Care Program on March 23. This Session is open to all stakeholders to share successes, ask questions and give feedback to improve program design. The entire session is anticipated to take approximately one hour; however, the session will conclude when all feedback is given. This is a free event, although registration is required. Click HERE to register.

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