Tennessee Pharmacists Association

Tennessee State Capitol

April 20, 2018

This week was an extremely important week for TPA pharmacy priority legislation! Several TPA-supported legislative initiatives are moving forward. Some of these bills are still being considered, so make sure to keep in touch with your elected officials. CLICK HERE to look up the contact information for your elected state Representative and state Senator.

PBM Licensing Through TN Dept of Commerce and Insurance – Passed!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation was passed by the House of Representatives on Tuesday, April 17, with only one dissenting vote. This legislation has already been passed by the Senate, so the bill will now move to Governor Haslam’s desk to be signed into law! 

Senate Sponsor(s): Haile, Crowe, Bell, Yager, Jackson, Reeves
House Sponsor(s): Powers, Matlock, Keisling, Weaver, Calfee, Terry

Summary:
  • Requires all pharmacy benefits managers (PBMs) to obtain licensure and renew biennially through the Tennessee Department of Commerce and Insurance (TDCI)
  • Requires PBMs to demonstrate that they are able to transact in this state, are financially responsible, and have not had a prior license denied or revoked within five (5) years of the date the license is sought
  • Requires PBMs to provide TDCI with the person or entity’s name, address, telephone number, and website address
  • Requires PBMs to notify TDCI within 60 days of any change in PBM information

PBM Anti-Gag Clause – Moving!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation containing the PBM anti-gag clause language was passed by the House of Representatives on Thursday, April 19. This legislation containing the pharmacist anti-gag clause amendment added by the House will now be considered by the Senate on Monday, April 23! 

This legislation, as amended by the House, would include language prohibiting so-called “Gag Clauses” in PBM contracts with pharmacies. These “Gag Clauses”, highlighted in a recent New York Times Article, are arbitrarily placed on pharmacists through contracts with Pharmacy Benefits Managers (PBMs) and prevent pharmacists from discussing lower cost medication therapies with patients.

Senate Sponsor(s): Crowe, Green, Massey, Haile, Reeves, Bailey, Bowling, Briggs
House Sponsor(s): Sexton C, Kumar, Terry, Whitson, Jernigan, White D

Summary as amended by the House:
  • Enacts annual hospital reporting and inspection requirements
  • Establishes that a pharmacy or pharmacist shall have the right to provide an insured information regarding the amount of the insured’s cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower priced drug to the insured if one is available.

Governor Haslam’s TN Together Opioid ReformAmended

Governor Haslam’s TN Together legislation was passed by the full House on Monday, April 9.  The Senate voted earlier this week to further amend the legislation to remove the requirement for the ICD-10 to be listed on the prescription. This ICD-10 language is critically important to implementing this law. Having this code on the prescription would assist the Tennessee Department of Health in reviewing patterns of opioid prescribing and help pharmacists to evaluate the intended purpose for opioid prescriptions. This debate is ongoing, and more updates will be provided as this legislation continues to be discussed.

The state has prepared an infographic summarizing the amended legislation. TPA has also prepared a summary of the amended legislation below.

Legislation: House Bill 1831 / Senate Bill 2257
Senate Sponsor(s): Norris, Haile, Yager, Massey
House Sponsor(s): Hawk, Casada, Kumar, Johnson, Sexton C, Terry, Powers, Coley, Daniel, Eldridge, Holsclaw, Favors, Hardaway

Summary as Amended:

Required Dispenser CSMD Checks:

  • Requires all dispensers (or their delegates) to check the Controlled Substance Monitoring Database (CSMD) prior to dispensing an opioid or a benzodiazepine the first time that human patient is dispensed a controlled substance at that practice site
  • Requires all dispensers (or their delegates) to check the CSMD again at least once every six (6) months for that human patient after the initial dispensing, for the duration of time the controlled substance is dispensed to that patient

Prescriber Documentation Requirements:

  • Requires prescribers to document specific elements prior to prescribing opioids, including informed consent and reasons for prescribing opioids
  • Dispensers (including pharmacists) have been removed from above documentation requirements

Opioid Prescriptions Written for 3-Day Supply or Less:

  • No required CSMD checks for prescribers or dispensers
  • No additional documentation requirements or partial fill restrictions
  • ICD-10 Codes are not required to be written on prescriptions
  • Maximum of 180 cumulative morphine milligram equivalents (MME)

Non-Exempt Opioid Prescriptions:

  • Must be partially filled with no more than a 5-day supply (for a 10-day prescription), or partially filled with no more than half the prescribed day supply limit (for prescriptions written for more than 10 days)
  • ICD-10 Codes (and “medical necessity” or “surgery”, if applicable) must be written on all non-exempt opioid prescriptions – ICD-10 requirement removed by Senate
  • General script limits: No more than a 10-day supply and a maximum of 500 cumulative MME
  • Surgery: No more than a 20-day supply and a maximum of 850 cumulative MME
  • Medical necessity: No more than a 30-day supply and a maximum of 1,200 cumulative MME

Exempt Opioid Prescriptions:

  • Partial fill requirements do not apply.
  • MME limits do not apply.
  • ICD-10 Codes and “Exempt” must be written on all Exempt Opioid Prescriptions – ICD-10 requirement removed by Senate
  • Exempt conditions: active or palliative cancer treatment, hospice care, diagnosis of Sickle Cell Disease, inpatients of a licensed healthcare facility, patients seen by pain management specialists, patients treated with opioids for 90 days or more in the last year OR who are subsequently treated for 90 days or more, patients on methadone, buprenorphine, or naltrexone, or patients with severe burns or major physical trauma

Pharmacist Anti-Gag Clause: Voids agreements which limit the pharmacists’ ability to discuss any issue related to the dispensing of a controlled substance, including risks, effects, and characteristics of the controlled substance; what to expect and how the controlled substance should be used; reasonable alternatives to controlled substance; and any applicable cost sharing for a controlled substance or any amount an individual would pay for a controlled substance if that individual were paying cash.

Effective DateThis law would become effective on July 1, 2018. However, the partial fill requirements of this law are not mandatory prior to January 1, 2019, for dispensers who have not updated the dispenser’s software system.


Professional Privilege Tax Repeal – Failed Due to Lack of Funding

This year’s legislative push to repeal the professional privilege tax failed to receive the necessary funding needed for it to move forward and will not be further considered this session. TPA appreciates the ongoing advocacy of members in discussing this issue with your legislators and will continue to work toward a full repeal of this burdensome provider tax.


Other Pharmacy-Related Legislation Being Considered in Tennessee

Authorization for Partial Filling of Controlled Substances

This legislation was passed by the full Senate unopposed on March 26. The House passed a different version of this legislation on April 12. There is a fundamental divide on the topic of prorated patient co-payment requirements. TPA will continue to work with members of both the House and Senate as each body considers this issue.

Summary as Amended: As introduced, authorizes a partial fill of a prescription of a controlled substance under certain conditions.

Pharmacist Dispensing of Prescription Drugs Prior to Authorization in Emergency Situations

Thanks to your support and advocacy, this legislation has been passed by both the Senate and House unanimously and has been signed by Governor Haslam as Public Chapter 615!

Summary as Amended: Authorizes a pharmacist in this state, in good faith, to dispense to a patient without proper authorization or a valid prescription, the number of dosages of a prescription drug necessary to allow the patient to secure proper authorization or a valid prescription from the patient’s prescriber. Prohibits the amount of the prescription drug being dispensed from exceeding a 20-day supply. Allows prescription information to be obtained from a prescription label, verbal medical order, verbal prescription order, or any other means determined to be legitimate in the professional judgment of the pharmacist.

Mandatory Electronic Prescribing for Schedule II Controlled Substances

This legislation was passed by the House and the Senate, and will now move to the Governor’s desk to be signed into law

Summary as Amended: Requires certain prescriptions, on or after January 1, 2020, for a Schedule II controlled substance in this state to be made as an electronic prescription from the person issuing the prescription to a pharmacy.

Rescheduling of Controlled Substances (including Gabapentin as Schedule V)

This legislation was passed by the full House on April 9. A different version of this legislation, which includes Kratom in the list of scheduled substances, passed the Senate on April 18. The amended Senate version of this legislation, with Kratom included, now goes back to the House for further consideration. 

Summary: Revises various provisions of law regarding the scheduling of controlled substances and their analogues and derivatives, including updated identifications of drugs categorized in Schedules I–V; authorizes sentence reduction credits for prisoners who successfully complete an intensive substance use disorder treatment program.

Medical Cannabis Only Act

This legislation was taken off notice in the Senate Health and Welfare Committee and will not be further considered in 2018.

TPA greatly appreciates your continued pharmacy advocacy and thanks you for your action in response to these specific legislative initiatives! For a more complete list of 2018 TPA Pharmacy-Related Legislative Priorities, CLICK HERE or visit the TPA website at https://tnpharm.org/get-involved/legislative-advocacy-center/tpa-announces-2018-legislative-priorities/.