(a) A pharmacy benefits manager shall notify a pharmacist who furnishes goods or services under any policy or contract for health insurance coverage provided under the TennCare program of the failure of any health insurer to provide timely payments for nondisputed claims pursuant to contract within fourteen (14) days of the failure of the health insurer to fund a scheduled payment.
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Terms Used In Tennessee Code 56-7-126

  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-1-102
  • Contract: A legal written agreement that becomes binding when signed.
  • Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds-type organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Tennessee Code 56-16-102
(b) Failure by a pharmacy benefits manager to provide notice as described in subsection (a) shall be cause for the commissioner to impose the appropriate penalties allowed in this title.
(c) As used in this section, “pharmacy benefits manager” means a person, business or other entity and any wholly or partially owned subsidiary of the entity, that administers the prescription drug or device portion of plans providing health insurance coverage on behalf of a third party, including plan sponsors, insurance companies, unions, and health maintenance organizations.
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