Federal Programs

Pharmacy Professionals Invited To TennCare Stakeholders Meeting

On January 21, 2016, the Centers for Medicare and Medicaid Services (CMS) published the federal Covered Outpatient Drugs Final Rule (CMS-2345-FC). The regulation requires state Medicaid programs, including TennCare, to update their reimbursement methodology for covered outpatient drugs. Under the final rule, states must reimburse covered outpatient drugs at actual acquisition cost plus a dispensing fee. The regulation requires all states to be in compliance with the reimbursement requirements of the final rule by April 1, 2017.

In order to meet the requirements of this new rule, the Bureau of TennCare has contracted with two vendors to conduct comprehensive surveys, in order to obtain the information needed from its valued Pharmacy partners to assist the Bureau in transitioning to the new reimbursement methodology. Both vendors, Myers & Stauffer LC and Mercer, are reputable firms with extensive experience in Pharmacy costs studies. Myers & Stauffer LC will be conducting a comprehensive study to determine the Actual Acquisition Costs (AAC) of drugs to TennCare participating Pharmacies. Mercer will be conducting a professional cost of dispensing survey. The primary goals of the State’s contracts with both Myers & Stauffer and Mercer are to develop and maintain a comprehensive reimbursement methodology that offers its Pharmacy partners accuracy, consistency and transparency in the rate setting process while complying with the new federal mandates.

The Tennessee Pharmacists Association encourages you to attend the initial stakeholder information session, which will be a webinar held on Tuesday, December 20th, at 9:30-11:00 am CST. The webinar will address these efforts and provide further background on how to participate in the survey.

Actual Acquisition Cost and Cost of Dispensing Survey
Stakeholders Meeting
Tuesday, December 20th
9:30-11:00 AM CST