Tennessee Pharmacists Association

Know the Rules
December 26, 2018

Pharmacy Benefits Manager (PBM) Licensing Through Tennessee Department of Commerce and Insurance
Legislation: Public Chapter 838

WHAT YOU NEED TO KNOW: 

On or before January 1, 2019, every pharmacy benefits manager (PBM) operating in Tennessee will be required to obtain a license with the Tennessee Department of Commerce and Insurance. This law is extremely important, because it establishes direct oversight of PBMs by state regulators.

Provisions of this new law:

  • 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

For more information on PBM laws in Tennessee, please visit TPA’s Practice-Based Resource Page on PBMs. TPA also provided members with detailed instructions regarding the TDCI complaint process, which can be found HERE.


Governor Haslam’s TN Together Opioid Reform Legislation: Public Chapter 1039 WHAT YOU NEED TO KNOW: 

Although many of the provisions in this law became effective July 1, 2018, the provisions requiring pharmacy documentation and submission of ICD-10 codes to the Controlled Substance Monitoring Database (CSMD) and the partial fill mandate provisions become effective on January 1, 2019.

Provisions of this new law (effective July 1, 2018):

  • Increases the frequency of required dispenser (or dispenser’s agent) checks of the CSMD for opioids and benzodiazepines to every 6 months
  • Establishes additional documentation and clinical steps for prescribers to perform and document before writing opioid prescriptions
  • Establishes morphine milligram equivalent (MME) thresholds for certain opioid prescriptions
  • Requires ICD-10 codes on all opioid prescriptions written for more than 3 days in duration or in quantities greater than 180 morphine milligram equivalents (MME)

Provisions of this new law (effective January 1, 2019):

  • Requires dispensers (pharmacists) to partially fill opioids in certain situations as established in the law (unless exempted)
  • Requires dispensers (pharmacists) to document and transmit ICD-10 codes for all opioid prescriptions written for more than 3 days in duration or in quantities greater than 180 morphine milligram equivalents (MME) to the CSMD

For more specific information on Governor Haslam’s TN Together law and opioid and prescription drug abuse, please visit TPA’s Practice-Based Resource Page on Opioids and Prescription Drug Abuse.


Partial Filling of Schedule II Controlled Substances Legislation: Public Chapter 1007 WHAT YOU NEED TO KNOW: 

TPA fought to protect pharmacists and pharmacies from adverse financial impact as a result of partial filling of controlled substances. Pharmacists should note that the pharmacy protection provisions contained in this partial fill law become effective January 1, 2019, for opioids and July 1, 2019, for all other schedule II controlled substances.

Provisions of this new law:

  • Authorizes the partial filling of a Schedule II 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 fill the remainder of 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 dispensed through a variety of methods, including submission of information to the CSMD
  • Requires prorated cost sharing and copayments for partial fills
  • Authorizes a pharmacist or pharmacy to charge a dispensing fee to cover the actual supply and labor costs for partial fills
  • Establishes protections for pharmacists against reductions in payment for partial fills by insurers and PBMs

Required Notice and Information on Suspected Opioid Abuse or Diversion Legislation: Public Chapter 675 WHAT YOU NEED TO KNOW: 

Effective January 1, 2019, all entities that prescribe, dispense, or handle opioids are required to provide information to employees about reporting suspected opioid abuse or diversion. The information must be made available to employees in one of the following ways:

  • The information may be provided to each employee individually in writing, documented by the employing entity; OR,
  • A sign at least 17 inches in width and 11 inches in height may be posted in a conspicuous location in a non-public area regularly used by employees, stating the following:

NOTICE: PLEASE REPORT ANY SUSPECTED ABUSE OR DIVERSION OF OPIOIDS, OR ANY OTHER IMPROPER BEHAVIOR WITH RESPECT TO OPIOIDS, TO THE DEPARTMENT OF HEALTH’S COMPLAINT INTAKE LINE: 1-800-852-2187

TPA has created a printable version of the sign described above as a benefit to members. Note that, in order to be compliant, it must be printed on paper that meets the specific size requirements of the law. Members may access the sign HERE.