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  • 1.  New TN PBM Bill

    Posted 26 days ago
    Hopefully a positive new trend!

    Release from ASHP: 

    Breaking News: Tennessee Governor Signs PBM Bill

    Last week, Tennessee Governor Bill Lee signed Senate Bill 2458/House Bill 2661 into law. The law protects patients and pharmacies from abusive pharmacy benefit manager (PBM) tactics by ensuring patients have access to the pharmacy of their choice, pharmacies are adequately compensated for medications and dispensing, and limiting payers' ability to require white bagging of clinician-administered drugs. The new law will be enforceable by the Tennessee Department of Commerce and Insurance (TDCI).

     

    Specifically, the new law addresses the following:

    • White Bagging: Payers may not interfere with a patient's right to obtain covered drugs, including specialty drugs, from their contracted pharmacy or provider of choice. Further, payers may not require patients to pay an additional fee, higher copays, or any other financial penalty when obtaining drugs from a contracted pharmacy or provider.
    • Reimbursement: The bill prohibits PBMs from reimbursing pharmacies less than the purchase price of prescription drugs and devices, and includes an appeals process that must be approved by the TDCI. Under the appeals process, the PBM has 7 days to reimburse a pharmacy at the proper rate and must waive or pay the cost of re-billing the claim. If a pharmacy loses a claim, the PBM has 7 days to provide information on where the product can be obtained at the lower reimbursement rate, or it will have to pay the pharmacy's actual cost.
    • Dispensing Fee: PBMs must match TennCare's enhanced dispensing rate for qualifying low-volume pharmacies. TennCare currently designates pharmacies dispensing less than 65,000 prescriptions per year as "low-volume" and pays an enhanced dispensing fee of $11.98.
    • Patient Steering and Network Restrictions: PBMs cannot interfere with a patient's choice of contracted pharmacy, including through use of financial incentives to switch to a PBM-owned or affiliated pharmacy. Additionally, pharmacies must be allowed to join a PBM's network if they are licensed in the state and willing to accept the terms and conditions for at least one of the PBM's networks in the state.

    "ASHP strongly supports efforts to address mandatory white bagging and other problematic PBM tactics through state legislation," said Tom Kraus, ASHP vice president of government relations. "We are thrilled to see Tennessee's success at taking on PBMs at the state level, and we look forward to helping our affiliates and members in other states pursue this strategy."

     

    Although the bill is now law, TDCI will need to promulgate regulations before some provisions can take effect. ASHP will continue to monitor the regulatory process and provide members with updates on other state-level efforts to address PBM abuses. Thank you to the Tennessee Pharmacists Association for their advocacy efforts to make this happen.

     

     



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    Eric Farmer
    Indiana University Health
    IndianapolisIN
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