At the conclusion of the 2022 Legislative Session, TPA created an FAQ resource to answer member questions regarding the PBM enforcement bill (PC 1070).

Why does the enhanced dispensing fee only apply to low-volume pharmacy locations?

• In the final weeks of the 2022 legislative session, many businesses and employer groups raised concerns about the costs to having a dispensing fee that mimicked the TennCare rate across all pharmacies in the state. TPA worked with stakeholders and legislative leadership that addressed the concerns about premium impact while maintaining the other protections contained in the bill. During the advocacy process, the dispensing fee provision was reduced to apply only to low-volume pharmacies based on the TennCare standards.

As a low-volume pharmacy, where do we submit our certification for the enhanced dispensing fee?

• The current process established by the state requires pharmacies to contact all PBMs that they work with the necessary certification to demonstrate they are a low-volume pharmacy.
• While this is not a comprehensive list, TPA has collected information on some PBMs to help you.

When will the state have regulations focusing on patient steerage provisions of the law?

• While patient steerage was not addressed in the emergency rules that were enacted, TPA will continue to urge the state to include regulations on patient steerage in ongoing changes to the rules on PBM enforcement.

Does the law apply to Medicare Part C/Medicare Advantage plans?

• The law and rules reference which plans are exempt from enforcement, which includes: health plans that provide coverage only for accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, other long-term care, or plans subject to regulation under Medicare Part D.
• As Medicare Advantage plans are not under this stipulation, TPA’s interpretation is the law does apply to Medicare Advantage plans. If a plan is in violation of the law or rules, TPA would encourage members to file a complaint with the Tennessee Department of Commerce and Insurance.