Tennessee Pharmacists Association

Tennessee State Capitol

April 30, 2018

The 110th Tennessee General Assembly adjourned last week. Thanks to the advocacy and engagement of our active members, TPA successfully achieved several very important legislative victories to support our patients and the pharmacy profession!

Although this year’s session has officially ended, 2018 will be a BIG year for elections, and your voice is critically important right now. More than a quarter of the seats in the state House, state Senate, and US Congressional delegation will be occupied with new legislators. Tennessee will also elect our next Governor of Tennessee this fall. All members are encouraged to reach out to your current and future legislators to make them aware of important pharmacy priorities prior to November’s elections.

Our TPA members consistently indicate that advocacy is one of the most important reasons for your continued membership and support. Please take a few moments to contact your state legislators to thank them for supporting TPA’s legislative pharmacy priorities. 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 and Senate. This legislation will now be transmitted to Governor Haslam’s desk to be signed into law!

Effective: January 1, 2019
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 – Passed!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation was passed by the House of Representatives and Senate. This legislation will now be transmitted to Governor Haslam’s desk to be signed into law!

This legislation enacts 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.

Effective: July 1, 2018
Senate Sponsor(s): Crowe, Green, Massey, Haile, Reeves, Bailey, Bowling, Briggs
House Sponsor(s): Sexton C, Kumar, Terry, Whitson, Jernigan, White D

Summary:

  • 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.
  • Updates existing code to include certain health care facilities in the list of facilities that are required to report individuals that have been involuntarily committed.

Governor Haslam’s TN Together Opioid Reform – Passed!

Governor Haslam’s TN Together legislation was passed by the House of Representatives and Senate. Thanks to the advocacy efforts of TPA, and especially pharmacist Senators Randy McNally, Ferrell Haile, and Shane Reeves, as well as Representatives Cameron Sexton and Bryan Terry, the ICD-10 requirement for opioid prescriptions was NOT removed from the legislation. This legislation will now be transmitted to Governor Haslam’s desk to be signed into law.

TPA worked extensively with state legislators and Governor Haslam’s administration over the course of this session to improve the original legislation, easing the burden on legitimate patients and minimizing overly cumbersome requirements for practicing pharmacists. While this legislation is well-intended, TPA remains concerned about the unintended consequences of the legislation on patients and the pharmacy profession. Decreasing the overall epidemic of prescription drug abuse and reducing patients’ risk of dependence are commonly shared goals of all pharmacy professionals and Tennesseans. However, the need for patient access to treatment and recovery services has never been greater, and our state must continue to seek solutions which help our patients struggling with dependence and addiction to get the help they desperately need. Reducing the supply of opioids is a step in the right direction, but TPA remains concerned that any further decrease in the prescription drug supply without providing needed access to treatment and recovery services may drive individuals to the streets to obtain illicit heroin and fentanyl, and may also result in individuals committing criminal acts, including pharmacy robberies and pharmacy burglaries, in order to illegally obtain these prescription drugs.

Legislation: Senate Bill 2257 / House Bill 1831
Effective: July 1, 2018 (partial fill requirements effective January 1, 2019)
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: (Infographic)

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
  • 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
  • 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 Date: This 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.


Scheduling of Gabapentin as Schedule V Controlled Substance –Passed!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation was passed by the House of Representatives and Senate. This legislation will now be transmitted to Governor Haslam’s desk to be signed into law!

Legislation: Senate Bill 2258 / House Bill 1832
Effective: July 1, 2018
Senate Sponsor(s): Norris, Yager, Haile
House Sponsor(s): Casada, Dunn, Harwell, Kumar, Love, Favors, Johnson, Hardaway, Terry, Thompson, Akbari, Camper, White M, Staples, Powers, Gilmore

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.
  • Requires Gabapentin to be scheduled as a Schedule V controlled substance within Tennessee code.
  • Authorizes sentence reduction credits for prisoners who successfully complete an intensive substance use disorder treatment program.
  • Establishes restrictions on the sale of the herbal substance kratom.

Partial Filling of Controlled Substances – Passed!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation was passed by the House of Representatives and Senate. TPA worked hard with state legislators and successfully fought to protect pharmacists and pharmacies from adverse financial impact, by including language that authorizes pharmacists and pharmacies to charge dispensing fees for each partial fill of a controlled substance, and by establishing that partial fills may not be used to reduce payments to pharmacists and pharmacies. This legislation will now be transmitted to Governor Haslam’s desk to be signed into law!

Legislation: Senate Bill 2025 / House Bill 2440
Effective: Upon becoming law (dispensing fee authorization and prorating of copay requirements effective January 1, 2019, for opioids and July 1, 2019, for all other controlled substances)
Senate Sponsor(s): Haile
House Sponsor(s): Terry, Sexton C, Ragan, Hardaway, Curcio

Summary:

  • Authorizes the partial filling of a controlled substance if the partial fill is requested by the patient or the practitioner who wrote the prescription and the total quantity dispensed through partial fills does not exceed the total quantity prescribed for the original prescription
  • Requires the pharmacist to retain the original prescription at the pharmacy where the prescription was first presented and the partial fill dispensed, and any subsequent fill shall occur at the pharmacy that initially dispensed the partial fill within thirty (30) days from issuance of the original prescription.
  • Requires the pharmacist to notify the prescriber of the partial fill and of the amount actually dispensed, either through a notation in the interoperable electronic health record of the patient, through submission of information to the controlled substance database, by electronic or facsimile transmission; or through a notation in the patient’s record that is maintained by the pharmacy, and that is accessible to the practitioner upon request.
  • Requires any person who presents a prescription for a partial fill to pay the prorated portion of cost sharing and copayments.
  • Authorizes a pharmacist or pharmacy to charge a dispensing fee to cover the actual supply and labor costs associated with the dispensing of the original prescription for a controlled substance and each partial fill associated with the original prescription.
  • Establishes that any cost sharing, copayment, dispensing fee, or any portion thereof, made to a pharmacist or pharmacy for the dispensing of a partial fill of a controlled substance shall not be considered an overpayment.
  • Establishes that a health insurance issuer or pharmacy benefits manager shall not utilize partial fills of a controlled substance to reduce payments to a pharmacist or pharmacy for dispensing multiple partial fills.

Dispensing By Pharmacists In Emergency Situations – Passed!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation was passed by the House of Representatives and Senate, and has been signed by Governor Haslam as Public Chapter 615!

Legislation: Senate Bill 1670 / House Bill 1695
Effective: July 1, 2018
Senate Sponsor(s): Green, Briggs
House Sponsor(s): Pitts, Terry, Reedy, Sexton C, Kumar, Sherrell, Hardaway

Summary:

  • 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.

Update to MTM Definition – Passed!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation was passed by the House of Representatives and Senate, and has been signed by Governor Haslam as Public Chapter 617!

Legislation: Senate Bill 1774 / House Bill 1874
Effective: July 1, 2018
Senate Sponsor(s): Crowe
House Sponsor(s): Kumar, Sexton C, Terry

Summary:

  • Establishes that a medication therapy management program is “pharmacist-provided”.

Mandatory Electronic Prescribing of Schedule II Controlled Substances – Passed!

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

Legislation: Senate Bill 2191 / House Bill 1993
Effective: January 1, 2020
Senate Sponsor(s): Lundberg
House Sponsor(s): Gant, Rudd, Travis, Keisling, Ragan, Reedy, Butt, Staples, Holsclaw, Williams, Whitson, Kumar, Sherrell, Harwell, Johnson, Moon, Zachary, Carr , Matlock, Shaw, Hawk, McCormick, Tillis, Marsh, Brooks K, White M, Howell, Fitzhugh, Halford, Powers, Hicks

Summary:

  • Requires certain prescriptions for a Schedule II controlled substance to be made as an electronic prescription from the person issuing the prescription to a pharmacy.
  • Requires the name, address, and telephone number of the collaborating physician of an advanced practice registered nurse or physician assistant to be included on the electronic prescription.

Buprenorphine Clinic Restrictions – Passed!

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

Legislation: Senate Bill 777 / House Bill 717
Effective: July 1, 2018
Senate Sponsor(s): Jackson, Yager
House Sponsor(s): Johnson, Sexton C, Eldridge, Powers

Summary:

  • Restricts the dispensing of buprenorphine products to nonresidential office-based opiate treatment facilities, nonresidential substitution-based treatment centers for opiate addiction, licensed pharmacies, or licensed hospitals.
  • Requires licensed pharmacies and distributors to report to the department of health the quantities of buprenorphine that the licensed pharmacy or distributor delivers to nonresidential office-based opiate treatment facilities.

Medical Cannabis Only Act – Failed

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


Professional Privilege Tax Repeal – Failed (Not Funded)

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.


Lockable Vials for Controlled Substances – Defeated!

If enacted, this legislation would have placed additional requirements for pharmacists to use lockable vials to dispense schedule II controlled substances in a lockable container. This legislation would have created burdensome and unnecessary requirements on pharmacists and patients. This legislation would have also added significant burdens on patients who are elderly and those who suffer from hearing loss, memory loss, mental illness, physical disabilities, arthritis, and other serious health conditions. This legislation attempted to legislate a business concept into Tennessee code and should not be required by law.


Required Vaccine Notifications – Defeated!

If enacted, this legislation would have placed additional requirements for immunizing pharmacists to provide patients with a list of vaccine ingredients, potential side effects on the vaccine manufacturer’s insert, and information about the purpose and availability of the federal vaccine adverse event reporting system (VAERS), prior to administration of every vaccine.

TPA greatly appreciates your continued pharmacy advocacy and thanks you for your action in response to these specific legislative initiatives!