Low Volume Dispense Fee

Legal Basis (Rule 0780‑01‑95‑.10)

Tennessee’s PBM rules specify eligibility, timing, proof, and payment obligations for the enhanced professional dispensing fee for low‑volume pharmacies. Eligibility mirrors TennCare’s low‑volume standard; pharmacies must certify with each PBM for the commercial market.

What Counts as “Low‑Volume” in Practice

The rule relies on TennCare’s standard for the enhanced dispensing fee. Industry guidance from the Tennessee Pharmacists Association (TPA) commonly references fewer than 65,000 prescriptions per year. Always confirm current values with TennCare/TPA before you certify for the next year.

Why Certification Matters (Operational & Financial Impact)

Failing to certify by December 1 (with proof) means you will not receive the enhanced fee on Jan 1. Timely certification ensures the correct fee is applied from the start of the calendar year and protects against recoupment if your certification is accurate. For late or new‑PBM situations, the rules ensure prompt application prospectively once a complete certification is received.

If you qualify that is an updated dispensing fee of $13.16! Not re-certifying can cost you hundreds.

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