PHARMACY BENEFITS MANAGER (PBM) LAWS
CLICK HERE to access the “Pharmacy Benefits Manager (PBM) Laws” resources listed below — EXCLUSIVELY FOR TPA MEMBERS.
|TPA is conducting a series of 30-minute OPEN-FORUM WEBINARS to share information about implementation of Public Chapter 569.|
CLICK HERE TO LEARN MORE.
|TPA members can link to recordings of the PC 569 webinars HERE as they become available.|
TPA continues to advocate for increased transparency and accountability for Pharmacy Benefits Managers (PBMs) at the state level. These enacted laws ensure that pharmacies have the ability to maintain a level playing field with respect to the practices of PBMs. Ongoing state advocacy efforts include protections for patient access to pharmacist-provided care, pharmacy audit restrictions, increased transparency and accountability for pharmacy payments from PBMs, and other essential laws listed below.
It is important to note that any laws enacted in Tennessee or any other state cannot be enforced on federally-funded programs, such as Medicare plans.
On the members-only Pharmacy Benefits Manager Laws resource page, TPA members have access to details about Tennessee’s 2021 PBM Reform law and other important PBM-related laws in Tennessee, including:
- Creation and oversight of the PBM process for state government programs (TCA Title 4)
- Prompt Pay Requirements (TCA 56-7-126)
- “Any Willing Pharmacy” Statute (TCA 56-7-2359) *NEW*
- Patient Choice Statute (TCA 56-7-3120)
- Standards for PBM Identification Cards (TCA 56-7-2361)
- Audit and Recoupment Restrictions for Pharmacy Services (TCA 56-7-2362)
- Pharmacy Audit Bill of Rights and Restrictions on MAC Lists (TCA 56-7-3101 through TCA 56-7-3112)
- Licensure as Pharmacy Benefits Manager (Mandatory PBM Licensure) (TCA 56-7-3113)
- Right to Provide Information Regarding Amount of Insured’s Cost Share of Prescription Drug (Prohibition on PBM Gag Clauses) (TCA 56-7-3114)
- Prohibition on PBMs from Assessing Retroactive, Non-Transparent Fees on Pharmacists or Pharmacies (TCA 56-7-3115)
- Prohibition on PBMs from Requiring Pharmacists to Dispense Contrary to Professional Judgment (TCA 56-7-3116)
- Prohibition on PBMs for Utilizing Spread Pricing and Prohibition Against Below Cost Claims (TCA 56-7-3206) *NEW*
- Disclosure of Material Changes to Contract Provisions (TCA 56-7-3117)
- Additional Contract Protections and Prohibited PBM Practices (TCA 56-7-3118)
- Discrimination Against 340B Entities (TCA 56-7-3119) *NEW*
- Cost Calculations and Pharmacy Right to Disclose Costs to Patients (TCA 56-7-3201 through TCA 56-7-3204)
- Real Time Benefit Tool (TCA 56-7-3208) *NEW*
- Audit and Recoupment Restrictions for Pharmacy Claims (TCA 56-32-138)
- PBM Authorization Statutes for TennCare (TCA 71-5-138, TCA 71-5-197, TCA 71-5-198)