Tennessee Pharmacists Association

April 12, 2019

On April 9, 2019, Governor Bill Lee signed one of TPA’s top 2019 legislative priorities into law as Public Chapter 124. The law became effectively immediately upon signing, although it was not published on the Secretary of State’s website until late on Friday, April 12, 2019.

This session, TPA and the Tennessee Medical Association worked together to introduce legislation addressing several important patient-centric issues identified during the implementation of Governor Haslam’s 2018 TN Together Opioid Reform Law. TPA members were instrumental in providing feedback about the specific issues related to challenges in implementation of this law, and TPA greatly appreciates the work of bill sponsors and members of the Tennessee General Assembly for recognizing the challenges and enacting this legislation. The new law will ease several of the more burdensome provisions placed on providers and ensure effective and uninterrupted care for patients for whom opioid therapies are necessary.

TPA would like to specifically recognize and thank Representative and House GOP Caucus Chairman Cameron Sexton and pharmacist and Senator Shane Reeves for carrying this important TPA priority legislation, as well as the members of the Tennessee General Assembly, for voting to enact this legislation that makes important patient-centric changes to last year’s TN Together law!


Public Chapter 124: Summary of Important Changes to TN Together

PARTIAL FILL MANDATE FOR OPIOIDS: This newly-enacted law changes the mandate on pharmacists to partially fill opioids, to being optional at the discretion of the prescriber or patient. 

What does this change mean for pharmacists

TN Together mandated that pharmacists must partial fill opioid prescriptions for up to 5 days, or no more than half the prescribed quantity. The newly-enacted law removes the requirement for pharmacists to partial fill opioids, and partial filling of opioids is now optional at the discretion of the prescriber, if the prescriber writes “partial fill” or “PF” on the prescription. Pharmacists may now dispense the full quantity of opioids that are prescribed. However, pharmacists should note that the existing day supply limits and Morphine Milligram Equivalents (MME) for 3-day, 10-day, and 30-day prescriptions still apply.

OPIOID PRESCRIPTIONS FOR SURGERY: This newly-enacted law changes the day supply and MME limit for prescriptions written for “Surgery”. 

What does this change mean for pharmacists

TN Together limited opioids prescribed for surgery to a 20-day supply and a limit of 850 MME for surgery, identified by prescribers as procedures that are more than minimally invasive. This newly-enacted law adjusts the day supply and MME limit for surgery for up to 30 days and a cap of 1200 MME, which is consistent with the “medical necessity” limit that currently exists in law.

OPIOID-CONTAINING COUGH SYRUPS: This newly-enacted law adds an exemption for opioids which are FDA-approved to treat upper respiratory symptoms or cough and prescribed for no more than fourteen (14) days.  

What does this change mean for pharmacists

TN Together did not exempt opioids approved for upper respiratory symptoms or cough. This newly-enacted law creates an exemption for opioids approved by the FDA to treat upper respiratory symptoms or cough (including cough syrups containing codeine or hydrocodone) prescribed for 14 days or less. The newly-enacted law establishes that these opioids are not subject to the requirements of TN Together, including the ICD-10 code requirements or MME limits. However, any opioids not approved for upper respiratory symptoms or cough or prescribed for more than 14 days are subject to the requirements of TN Together.

ELECTRONIC PRESCRIBING OF ALL CONTROLLED SUBSTANCES: This newly-enacted law changes the electronic prescribing requirements to include all schedules II-V by January 1, 2021. 

What does this change mean for pharmacists

TN Together required all schedule II controlled substances to be electronically prescribed by January 1, 2020. In 2018, the federal government enacted H.R. 6 (SUPPORT for Patients and Communities Act), which requires all schedules of controlled substances to be electronically prescribed for Medicare patients by January 1, 2021. Tennessee’s newly-enacted law delays the previous electronic prescribing compliance deadline of January 1, 2020, for schedule II controlled substances, and aligns Tennessee law with federal law requiring all schedules of controlled substances to be electronically prescribed by January 1, 2021. This change does not affect the existing electronic prescribing exemptions in TCA 63-1-160.

CLARIFYING LANGUAGE FOR “EXEMPT” PRESCRIPTIONS: This newly-enacted law changes the definitions for several categories of “Exempt” prescriptions. 

What does this change mean for pharmacists

TN Together established several different categories for “Exempt” prescriptions. However, several of these “Exempt” categories were unclear or vague. The newly-enacted law better clarifies two specific sections in the “Exempt” category for prescribers.

NO ICD-10 CODE ON 3 DAY / 180 MME PRESCRIPTIONS: This newly-enacted law establishes that prescriptions for no more than three (3) days or less than 180 MME do not require an ICD-10 code. 

What does this change mean for pharmacists

TN Together did not require opioid prescriptions for three (3) days or less and no more than 180 MME to have an ICD-10 code. However, conflicting interpretations of the law led to default requirements that all opioid prescriptions must contain an ICD-10 code. This newly-enacted law explicitly states that opioid prescriptions written for no more than three (3) days and no more than 180 MME do not require an ICD-10 code.

EXPIRATION DATES FOR SUBSEQUENT FILLS: This newly-enacted law clarifies the expiration dates for subsequent fills of partially filled controlled substances.  

What does this change mean for pharmacists

TN Together established a requirement that any subsequent fill of a partially filled controlled substance must be filled within thirty (30) days from issuance of the original prescription. However, the federal government, through enactment of the Comprehensive Addiction and Recovery Act (CARA) of 2016, and the Drug Enforcement Administration (DEA), have established different expiration dates for subsequent fills of partially filled controlled substances. These expiration dates vary depending on the schedule of the controlled substance and the patient’s condition being treated. Tennessee’s newly-enacted law allows for different expiration dates for partially filled opioids and other controlled substances based on the schedule of the controlled substance and the patient’s condition being treated.

PRORATING OF COST-SHARING AND CO-PAYMENTS FOR PARTIAL FILLS: This newly-enacted law removes provisions in the previous law which required prorating of a patient’s cost-sharing and co-payment for partial fills of controlled substances. 

What does this change mean for pharmacists

TN Together required pharmacists to collect a prorated portion of the patient’s cost-sharing and co-payment for partial fills of opioids and other controlled substances. This newly-enacted law removes the requirement for pharmacists to collect a prorated cost-sharing or co-payment from patients for each partial fill. However, the pharmacist’s ability to collect an additional dispensing fee for each partial fill was not removed.

PHARMACY DISPENSING SOFTWARE VENDORS: This newly-enacted law establishes that all pharmacy dispensing software vendors operating in Tennessee must update their software systems to allow for partial filling of controlled substances by January 1, 2021. 

What does this change mean for pharmacists?

TN Together required pharmacists to partial fill opioid prescriptions, but one of the primary issues identified by members prior to implementation of the law was the inability of pharmacy dispensing software systems to properly handle and process partial fills for opioids and other controlled substances. This newly-enacted law establishes a deadline for pharmacy dispensing software vendors to update their systems and allow for partial filling of opioids and other controlled substances.


TPA has prepared a detailed summary of the changes above, which can be accessed HERE. TPA has also updated the information on TPA’s Practice-Based Resource on Opioid and Prescription Drug Abuse to reflect these changes.