Bill > SB2576

This bill, concerning pharmacy benefits managers (PBMs), establishes new minimum reimbursement rates for pharmacies when PBMs pay for prescription drugs, devices, or pharmacy services. Specifically, a PBM cannot reimburse a contracted pharmacy less than the pharmacy's actual cost, 105% of the National Average Drug Acquisition Cost (NADAC) as published by the Centers for Medicare & Medicaid Services (CMS), the Wholesale Acquisition Cost (WAC) if NADAC is unavailable, or the amount the PBM reimburses itself or an affiliate for the same product. The bill also outlines a process for pharmacies to appeal reimbursement rates, requiring PBMs to pay double the amount owed if they fail to meet these minimums, and mandates that PBMs apply successful appeal findings to all remaining refills of a prescription. Furthermore, PBMs are prohibited from including professional dispensing fees in the reimbursement calculation for drugs or services and must pay a professional dispensing fee at least equal to what TennCare pays, without passing this cost to patients. These provisions aim to ensure fair reimbursement for pharmacies and are set to take effect on July 1, 2026, applying to new or modified contracts thereafter.

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https://wapp.capitol.tn.gov/apps/Billinfo/Default?BillNumber=SB2576&ga=114