Who has your back??
- Kayla Copeland
- Jun 30
- 2 min read
Tennessee Department of Commerce and Insurance
The Tennessee MAC appeal process is governed by Tennessee Code Annotated (TCA) 56-7-3206, enacted as part of Public Chapter 1070 of the 112th Tennessee General Assembly in 2022.
The Tennessee Department of Commerce and Insurance (TDCI) enforce regulations under TCA Title 56. The department oversee PBMs to ensure fair pharmacy reimbursement and good practices.
Tennessee’s PBM regulations have grew to address concerns of transparency, reimbursement practices, and the PBM impact on pharmacies and patients. By enforcing transparency, providing an appeal process, auditing PBMs, and requiring regular updates to reimbursement lists, Tennessee aims to make the PBM market predictable and equitable for pharmacies. In turn, allowing pharmacies to manage financial decisions easier to provide constant care to patients.
Patients and pharmacies alike can file complaints with TDCI if they believe the PBM are not adhering to regulations. Valid complaints can lead to a PBM investigation, penalties, or corrective actions.
500 James Robertson Pkwy
Nashville TN 37243-0565
(612)741-2241
PBM COMPLIANCE
(833)379-5080
Myers & Stauffer
Myers and Stauffer LC is a contractor responsible for administering the external appeal process for the review and resolution of appeals by pharmacies challenging payments made by pharmacy benefit managers (PBM) that were not paid at the pharmacy’s actual cost as defined in Tenn. Code Ann. §56-7-3206(h)(1).
Submitting an external appeal can be done directly on their website, mailing, or faxing. There is also a bulk submission option. I Suggest a pharmacy keep the same ‘PBM response date’ when submitting bulk appeals, this will ensure proper timely filing.
ATTN: TN PBM Pharmacy Appeals
800 E. 96th St., Suite 200
Indianapolis, IN 46240
(800)591-1183
8am — 8pm ET, Mon-Fri
Fax:
ATTN: TN PBM Pharmacy Appeals
(317)815-2971
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