TPREF has created the PBM Playbook educational series to guide Tennesseans through the complexities of PBM laws and regulations in Tennessee. With current programs focused on mastering the reimbursement appeals process or protecting your pharmacy from audits, the PBM Playbook educational series will educate you on understanding PBM reform laws and rules in Tennessee.
This educational series aims to empower community and outpatient pharmacists and pharmacy staff members with knowledge and tools to navigate the complexities of Tennessee’s PBM regulations and enhance patient care. The webinars are self-guided and allows learners to understand the regulatory landscape in Tennessee, master compliance requirements, and implement best practices for handling PBM interactions.
Don’t miss these opportunities to enhance your knowledge and skills in PBM reform and compliance. Take a look at the drop-down menu to learn of the current opportunities and upcoming webinars and register below!
Testimonials
“After participating in TPA’s PBM Playbook webinar, our pharmacy began filing appeals and saw immediate results. In just two months, we filed 29 appeals and recovered nearly $1,500—helping ensure we weren’t dispensing at a loss. By tracking negative pricing and applying what we learned, we were able to reduce losses by more than $1,400 in two months. The program quickly paid for itself and continues to provide value. I highly recommend this resource to other pharmacies.”
-Pharmacy in East Tennessee
Questions?
If you have questions, please contact TPA.
Mastering Reimbursement Appeals in Tennessee
Presenter
“PBM Playbook: Mastering Reimbursement Appeals in Tennessee” is presented by Tyler Dougherty, PharmD, BCACP, an esteemed expert in pharmacy benefit management reform and compliance.
Dr. Dougherty is an Associate Professor of Pharmacy Practice at South College School of Pharmacy and a practicing community pharmacist. He teaches on topics including pharmacy law, calculations, immunizations, and chronic disease management while also implementing enhanced pharmacy services that focus on collaborative practice, workflow processes, and cost savings. He received his Doctor of Pharmacy degree from the University of Tennessee College of Pharmacy and completed a PGY-1 with South College and Kroger. He lives in Knoxville, TN, with his wife, Stacie, and two children, Xavier and Peyton.
Program Objectives
To provide pharmacists with a clear understanding of PBM reforms and the TDCI regulatory framework.
To train pharmacists on compliance with TDCI rules and statutes, including record-keeping, reporting, and auditing.
To share effective strategies for submitting and managing MAC appeals, thus enabling pharmacists to advocate for their patients.
To offer insights into successful handling of PBM disputes and reimbursement challenges.
To promote best practices for engaging with PBMs and achieving optimal outcomes for patients and pharmacies.
Learning Objectives
Part 1
Understand the key provisions of the Pharmacy Benefit Manager (PBM) reform statue passed in Tennessee
Review the rules established by the Tennessee Department of Commerce and Insurance (TDCI) to enforce the PBM reform status
Describe the timeline of a pharmacy filing an initial appeal with a PBM
Differentiate between an External Appeal and a PBM Complaint
Part 2
Identify applicable claims eligible for appeal according to TDCI Regulations
Recall PBM specific requirements when submitting an appeal
Evaluate workflow considerations and priorities for implementation of appeals in your pharmacy
Pricing
TPA Member: $200
TPA Non-Member: $350
Registration
After completing your purchase, you will receive an email from LecturePanda to access both webinar series recordings.
Attendees must register individually.
Registration fees are non-refundable and non-transferrable under any circumstances.
Accreditation
UAN Part 1: 0575-0000-26-044-HO4-P/0575-0000-26-044-HO4-T
UAN Part 2: 0575-0000-26-045-H04-P/0575-0000-26-045-H04-T
Expires: 2/24/2029
The Tennessee Pharmacists Consortium for Education (TPCE) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This series is available as two webinars each one (1.0) hour of ACPE-accredited continuing pharmacy education to pharmacists and pharmacy technicians who attend the program and complete the online evaluation required to claim credit.
Audit Prevention
Webinar information coming soon