(a) A pharmacy benefits manager or covered entity shall make available to each pharmacy with which the pharmacy benefits manager or covered entity has a contract and to each pharmacy included in a network of pharmacies served by a pharmacy services administrative organization with which the pharmacy benefits manager or covered entity has a contract, at the beginning of the term of a contract and upon renewal of a contract:

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Terms Used In Tennessee Code 56-7-3107

  • Contract: A legal written agreement that becomes binding when signed.
  • Maximum allowable cost: means the maximum amount that a pharmacy benefits manager or covered entity will reimburse a pharmacy for the cost of a drug or a medical product or device. See Tennessee Code 56-7-3102
  • Maximum allowable cost list: means a list of drugs, medical products or devices, or both medical products and devices, for which a maximum allowable cost has been established by a pharmacy benefits manager or covered entity. See Tennessee Code 56-7-3102
  • Pharmacy benefits manager: includes , but is not limited to, a health insurance issuer, managed health insurance issuer as defined in §. See Tennessee Code 56-7-3102
  • Pharmacy services administrative organization: means an entity that provides contracting and other administrative services to pharmacies to assist them in their interaction with third-party payers, pharmacy benefits managers, drug wholesalers, and other entities. See Tennessee Code 56-7-3102
(1) The sources used to determine the maximum allowable costs for the drugs and medical products and devices on each maximum allowable cost list;
(2) Every maximum allowable cost for individual drugs used by that pharmacy benefits manager or covered entity for patients served by that contracted pharmacy; and
(3) Upon request, every maximum allowable cost list used by that pharmacy benefits manager or covered entity for patients served by that contracted pharmacy.
(b) A pharmacy benefits manager or covered entity shall:

(1) Update each maximum allowable cost list at least every three (3) business days, as required by § 56-7-3104(b);
(2) Make the updated lists available to every pharmacy with which the pharmacy benefits manager or covered entity has a contract and to every pharmacy included in a network of pharmacies served by a pharmacy services administrative organization with which the pharmacy benefits manager or covered entity has a contract, in a readily accessible, secure and usable web-based format or other comparable format or process; and
(3) Utilize the updated maximum allowable costs to calculate the payments made to the contracted pharmacies within five (5) business days.
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