Pharmacy Benefits Managers
Notice - New Rules have become effective as of June 27, 2023. See the Rules and Regulations section below for a copy of these rules.
File a Complaint
The form to file a formal complaint about Pharmacy Benefits Managers can be accessed here: Pharmacy Benefits Manager Complaint Form.
When submitting a complaint, be sure to include as much information as possible. For examples of supporting documentation, please see the guidance provided here: Pharmacy Benefits Manager Complaints: Supporting Documentation.
Pharmacy Benefits Manager Reimbursement Appeals
Tennessee pharmacy providers may appeal their reimbursement from pharmacy benefits managers (PBM) for drugs and devices due to the passage of Public Chapter 1070 by the Tennessee General Assembly. The law was signed by Tennessee Governor Bill Lee, May 25th, 2022.
Pharmacies should file their reimbursement appeal directly with the Pharmacy Benefits Manager. The standardized form to file an appeal with the PBM can be accessed here: Standard Pharmacy Reimbursement Appeal Form. Pharmacies and entities appealing on their behalf must be allowed to use this standardized form.
External Appeal Process for Reimbursement Appeals
Pursuant to Tennessee Code Annotated 56-7-3206(g)(2), the Department has established an external appeal process to review reimbursement appeals denied by pharmacy benefits managers. The Tennessee Department of Commerce and Insurance has contracted with Myers and Stauffer LC to review and resolve external appeals for pharmacy reimbursement. Pharmacy providers can contact Myers and Stauffer by the contact information listed below.
Help Desk: (800) 591-1183
Fax: (317) 815-2971
Contact Tennessee Department of Commerce and Insurance Pharmacy Benefits Manager Compliance
PBM.Compliance@tn.gov or 1-833-379-5080
PBM License Lookup
To view a list of licensed PBMs, click the following link: https://search.cloud.commerce.tn.gov/search?keyword=PBM
Rules and Regulations for Pharmacy Benefits Managers