Reminder: The Bureau of TennCare issued a provider notice summarizing PDL changes for the TennCare pharmacy program that are effective January 1, 2014. TPA members may access the notice HERE.
In a separate notice, the Bureau of TennCare announced that, on January 1, 2014, TennCare would begin coverage of benzodiazepine and barbiturate products, as required by the Affordable Care Act. A number of stipulations apply, however, and members are urged to read the notice, the full text of which is reprinted below.
From the Bureau of TennCare:
This notice is being sent to notify you of PDL changes for the TennCare pharmacy program regarding benzodiazepine and barbiturate products. In order to comply with the Affordable Care Act TennCare must begin coverage of these agents. As a result effective January 1, 2014, TennCare will begin covering barbiturates and benzodiazepines. We encourage you to read this notice thoroughly and contact Magellan’s Pharmacy Support Center (866-434-5520) should you have additional questions.
Effective January 1, 2014, TennCare will begin to cover benzodiazepines and barbiturates; however, all benzodiazepines and barbiturates will be subject to prior authorization and will only be approved for FDA-approved indications. While PA criteria for individual agents may vary, in general prior authorization criteria for these agents will require trial and failure of preferred agents from other classes listed on the TennCare Preferred Drug List (PDL). The updated PDL will be available online January 1, 2014. For complete information regarding preferred agents and criteria refer to: https://tenncare.
Please be aware that due to the risk of toxicitities with benzodiazepines patient should also meet the following additional requirements:
- Patient should not be pregnant
- Patients should NOT be concurrently taking CNS stimulants, opiates, carisoprodol, meprobamate, or barbiturates AND
- Due to increased risk of dependency, patient does not have a history of alcohol or drug dependence/abuse
NOTE: Prescribers must also be registered as a Medicaid Provider. For prescribers who have not registered as a Medicaid Provider, please refer prescribers to the following link for additional information: http://www.tn.gov/tenncare/
Health Providers: Please do not attempt to seek a prior authorization for these agents if the patient does not meet the posted criteria. Requesting prior authorizations for patients who do not meet criteria only increases expenditures for the State and decreases efficiency rates for other providers to obtain prior approvals for other agents and delays members from receiving care.