TPA has worked with state legislators to introduce comprehensive PBM reform legislation that includes pharmacy contract and audit protections, a ban on PBM use of retroactive fees, and increased PBM transparency.

Legislation:

• Senate Bill 650 by Reeves, Haile, Swann, Yager
• House Bill 786 by Sexton C, Terry, Powers, Sparks

Summary: As introduced, makes various changes to law concerning pharmacy benefits managers; requires the comptroller of the treasury to perform an annual audit of all pharmacy benefits managers providing services funded by the state.

Here’s how this legislation would affect the pharmacy profession:

• Strengthens audit protections regarding pharmacy’s right to amend claims prior to recoupment.
• Prohibits PBMs from recouping the cost of the drug or dispensed product through audit, except in cases of fraud, excess dispensing, and dispensing outside of prescriber’s orders.
• Prohibits PBMs from charging retroactive fees (e.g., DIR fees) to pharmacists or pharmacies at the state level.
• Prohibits PBMs from using contractual language to require a pharmacist to dispense a drug or product to a patient.
• Establishes notification requirements for PBMs regarding a pharmacy’s network status.
• Establishes prohibitions on PBMs from notifying patients until the pharmacy has received notification of removal.
• Requires PBMs to disclose any material change to contracts to a pharmacy or pharmacist in its network at least thirty (30) days before the effective date of the change.
• Requires the state Comptroller’s office to perform an audit of all state-funded PBMs and report audit results to certain legislative committees.
• Establishes certain contract standards and prohibitions between PBMs and pharmacies.
• Establishes that PBMs shall not reimburse a pharmacy or pharmacist less than it would reimburse itself or an affiliate for providing the same drug or dispensed product.

• Removes the state’s authority to contract with pharmacy benefits managers for any state-funded insurance plans, including plans for state employees and the TennCare program.
• Establishes that the state’s citizens would be better served by using the public money currently expended on state-funded pharmacy benefits managers to instead fund efforts to curb substance abuse.

• Modifies mandatory partial fill of opioid prescriptions to authorize prescribers to voluntarily request partial fills of opioids for patients while encouraging providers to write for the lowest effective amount.
• Requires pharmacy dispensing software systems to be compliant with the partial fill requirement originally passed last year by January 1, 2020.
• Establishes that the partial fill provisions of TN Together are not intended to supersede existing DEA rules allowing for partial fill of schedules III-V, or partial fill for long-term care or terminally ill patients, which are already permitted under federal DEA rules.
• Establishes that the opioid limits of TN Together do not apply to codeine and opioid-containing cough syrups that have been approved by the Food and Drug Administration to treat upper respiratory symptoms or cough.
• Aligns Tennessee electronic prescribing requirements set to take effect in 2020 to include all controlled substances and be consistent with federal e-prescribing regulations by January 1, 2021.
• Grants peer review committees at hospitals and medical group practices access to reports from the state’s Controlled Substance Monitoring Database, so they can better monitor and improve their internal prescribing patterns.
• Clarifies the surgery provision in the current law to better distinguish between major and minor surgeries.
• Defines the palliative care exemption so patients with terminal illness can have full access to effective pain management.

• Similar to the repeal of other state taxes, including the inheritance tax and the Hall tax, this legislation would take a multi-year, phase-out approach by repealing the professional privilege tax over the next few years.

• Requires dispensing facilities to ensure that every patient receives a medication therapy management consultation with a qualified pharmacist prior to the first time cannabis products are dispensed to the patient and annually thereafter.
• Requires dispensing facilities to ensure that a patient is offered the opportunity to consult with a pharmacist prior to each time cannabis products are dispensed.
• Consultations with qualified pharmacists may be in person or via telephone or other live electronic communication.
• Establishes certain liability protections for pharmacists who provide consultations to patients as part of a medical cannabis program.

• Prevents early access to nicotine-containing products by raising the minimum age of persons allowed to use tobacco and vapor products from 18 years of age to 21 years of age.

• This legislation would place additional requirements for pharmacists to dispense schedule II opioids and stimulants, as well as schedule IV benzodiazepines, in a vial with a lockable cap.
• This legislation would create burdensome and unnecessary requirements on pharmacists and patients, requiring pharmacists to keep up with and track millions of different combinations for caps.
• This legislation would add 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.
• These requirements would not reduce the diversion and misuse of opioids and would take time and effort away from pharmacists that could be better spent having important conversations with patients about reducing the amount of opioids and other controlled substances.
• This legislation is anti-free market and attempts to legislate a business concept into law. The business should instead market to pharmacies to encourage voluntary uptake of the product.