(a) The bureau of TennCare is authorized to remove pharmacy services from managed care organization (MCO) contracts and assume direct responsibility for all TennCare pharmacy purchases.
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Terms Used In Tennessee Code 71-5-197

  • Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
  • 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
(b) The bureau of TennCare is authorized to implement, either independently or in combination with a state preferred drug list (PDL), cost saving measures for pharmaceutical services, including, but not limited to, tiered co-payments, reference pricing, prior authorization and step therapy requirements; provided, however, that any prior approval process shall, at a minimum, comply with 42 U.S.C. § 1396r-8(d)(5), which requires a response to a request for prior authorization within twenty-four (24) hours and further requires at least a seventy-two (72) hour supply of a covered outpatient drug in an emergency situation.
(c) The bureau of TennCare, through a state pharmacy benefit manager (PBM) or on its own, is authorized to negotiate supplemental manufacturer rebates for TennCare prescription drug purchases; provided, however, that when conducting such negotiations, the bureau or PBM, or both, shall utilize the average manufacturer’s price (AMP) as defined in 42 U.S.C. § 1396r-8(k)(1) or any other recognized acceptable basis for negotiating rebates as the cost basis for the product.
(d) Notwithstanding any other law to the contrary, all information and documents containing trade secrets, proprietary information, rebate amounts for individual drugs or individual manufacturers, percent of rebate for individual drugs or individual manufacturers, and manufacturer’s pricing that are contained in records of the TennCare bureau, the state of Tennessee and its agents shall be confidential and shall not be a public record for the purposes of title 10, chapter 7, part 5. Nothing in this subsection (d) shall be construed to prohibit the TennCare bureau and the state of Tennessee from disclosing the information covered by this subsection (d) to members of the state TennCare pharmacy advisory committee, who shall be deemed agents of the state of Tennessee for purposes of this subsection (d).
(e) Notwithstanding any other law to the contrary, those portions of meetings of the state TennCare pharmacy advisory committee at which information described in subsection (d) is disclosed for discussion are exempt from title 8, chapter 44.
(f)

(1) The bureau of TennCare shall promulgate rules to promote the safe and responsible coverage of opioids for TennCare members who have the TennCare pharmacy benefit. The rules must, at a minimum, address prior authorization requirements for opioid prescriptions, as determined by the bureau, to reduce the development of opioid dependency and addiction. For women of child-bearing age, when prior authorization is required for an opioid prescription, the rules must require the provider to submit information regarding pregnancy status, contraceptive use, and the provision of counseling regarding the risks of becoming pregnant while receiving opioid medication. The information regarding pregnancy status and contraceptive use may, when appropriate, be based on self-reporting by the patient.
(2) The rules required by this subsection (f) shall be promulgated pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. On or before January 1, 2019, the bureau shall report to both the health and welfare committee of the senate and the health committee of the house of representatives regarding the status of the rules required by this subsection (f).
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