(a) The TennCare pharmacy advisory committee shall submit to the bureau of TennCare both specific and general recommendations for drugs to be included on any state preferred drug list (PDL) adopted by the bureau. In making its recommendations, the committee shall consider factors including, but not limited to, efficacy, the use of generic drugs and therapeutic equivalent drugs, and cost information related to each drug. The committee shall also submit recommendations to the bureau regarding computerized, voice, and written prior authorization, including prior authorization criteria, and step therapy.
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Terms Used In Tennessee Code 71-5-2404

  • Fraud: Intentional deception resulting in injury to another.
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
(b) The state TennCare pharmacy advisory committee shall include evidence-based research in making its recommendations for drugs to be included on the PDL.
(c)

(1) Any individual shall be permitted to make a public presentation to the TennCare pharmacy advisory committee regarding a drug or classes of drugs under consideration for the TennCare preferred drug list, in accordance with the following:

(A) A presentation shall be limited to an agenda item and there shall be a maximum of three (3) presentations per agenda item;
(B) A request to make a verbal presentation shall be submitted in writing by fax or electronically to the pharmacy director of the bureau of TennCare, or the named designee, with a copy to the chairman of the TennCare pharmacy advisory committee no later than seventy-two (72) hours in advance of the scheduled meeting;
(C) The time limit for a verbal presentation by or on behalf of a pharmaceutical manufacturer shall not exceed five (5) minutes in aggregate per drug per manufacturer or organization, or five (5) minutes by an individual, manufacturer or organization speaking on a particular position. The committee may, by a unanimous vote, extend the time limitation for presentation; and
(D) An individual, manufacturer or organization may present updated or new information, including drug package insert changes, new indications or peer-reviewed journal articles on a product.
(2) The committee may receive written studies, data and information relative to the cost-effectiveness of drugs being considered for placement on the preferred drug list. Such written information shall be distributed to the TennCare pharmacy advisory committee members. Such written information must be received by the TennCare pharmacy director no later than five (5) business days prior to the scheduled pharmacy advisory committee meeting.
(d) TennCare or its designee shall provide the state TennCare pharmacy advisory committee, the office of inspector general, and the state’s medicaid fraud control unit with clinical and economic research and utilization information as requested on drugs and drug classes.
(e) The TennCare bureau shall consider the recommendations of the state TennCare pharmacy advisory committee in amending or revising any PDL adopted by the bureau to apply to pharmacy expenditures within the TennCare program. The recommendations of the committee are advisory only, and the bureau may adopt or amend a PDL regardless of whether it has received any recommendations from the committee. It is the legislative intent that, insofar as practical, the TennCare bureau shall have the benefit of the committee’s recommendations prior to implementing a PDL or portions thereof.
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