Kayla Copeland

Pharmacies, listen up. It has come to my attention that Express Scripts (ESI) is manipulating the MAC appeal system. Pharmacies across Tennessee are reversing and rebilling approved MAC appeals — exactly as required — only to be hit with lowered reimbursement and increased patient copays. In many cases, the difference is hundreds of dollars, not just a few. Pharmacies are being forced to call patients — whose prescriptions are ready for pickup or already picked up — and tell them they...

Regarding ESI copayment increase. These instructions are designed to make the process fast, consistent, and simple for pharmacy teams AND your patients. ⚠️ IMPORTANT: TDCI does  not  need hundreds of duplicate complaints.You only need to submit  1–2 strong, well-documented complaints PER PLAN  (different BIN / PCN / GROUP). Below are the complete pharmacy and patient workflows. 💊 PART A — PHARMACY PROCESS (PBM Contact → Documentation → Submit TDCI PBM Complaint) A1. Contact ESI’s MAC...

Understanding legislation transforms future pharmacists from passive participants into informed changed agents.