Unlock FAIR reimbursement
Tennessee has enacted laws aimed at ensuring fair reimbursement for pharmacies. This includes the right to appeal reimbursements from PBMs that are below the pharmacy's actual cost for a drug. Recent amendments to these laws have further clarified the appeals process and set timelines for PBM responses.
Understand your rights.
Understand your rights regarding reimbursement: Familiarize yourself with Public Chapter 1070, which provides pharmacies the right to appeal reimbursement. Utilize the tools we have as Tennessee pharmacies to hold PBMs to fair standards.
PBMs do NOT have the last word...
Pharmacies in Tennessee have the right to appeal reimbursement decisions made by PBMs. The Tennessee Department of Commerce and Insurance has established an external appeal process for reimbursement appeals denied by PBMs, contracting with a third party to review these appeals. Standardized forms for initial appeals to PBMs and external appeals are available.
call to action
Filing a single appeal can indeed be a significant first step in becoming an advocate for Tennessee pharmacies, extending far beyond the walls of your own business. It's about recognizing that the challenges you face with reimbursement and PBM practices are likely shared by many other pharmacies across the state.
By taking that initial action, you're not just trying to resolve an issue for yourself; you're contributing to a larger movement. It's about documenting instances of unfair practices and demonstrating the need for systemic change. Each appeal filed adds to the collective evidence that can be used to push for legislative and regulatory reforms.
The idea of a unified voice is absolutely key. When individual pharmacies speak out, their concerns might be easier to dismiss. However, when a chorus of voices rises together, it becomes much harder to ignore. Sharing information, collaborating on strategies, and supporting each other's efforts can amplify the impact of each individual action.
Legal Disclaimer
The information provided on this website, LJAConsultingMac.com, is for general informational purposes only and does not constitute professional advice, whether legal, financial, technical, or otherwise. All content on this site is provided in good faith; however, LJA Consulting Mac makes no representations or warranties of any kind, express or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any information.
Under no circumstance shall LJA Consulting Mac, its affiliates, partners, or employees be held liable for any loss or damage of any kind incurred as a result of the use of the site or reliance on any information provided on the site. Your use of the site and your reliance on any information is solely at your own risk.
External links may be provided for your convenience, but LJA Consulting Mac does not endorse or take responsibility for the content or reliability of any third-party websites.
We reserve the right to make additions, deletions, or modifications to the contents of this website at any time without prior notice.
If you require specific advice, please contact us directly for personalized consultation.