TDCI Announces Myers and Stauffer LC Chosen to Administer PBM Appeal

Tuesday, May 16, 2023 | 08:37am

NASHVILLE – The Tennessee Department of Commerce & Insurance (“TDCI”) announces that the accounting firm Myers and Stauffer LC will begin administering pharmacy reimbursement external appeals on Tuesday, May 16, 2023. 

With the passage of Public Chapter 1070 in 2022 by the Tennessee General Assembly, pharmacy providers can appeal their reimbursement received from pharmacy benefits managers (“PBMs”) for prescription drugs and medical devices to TDCI. The passage of Public Chapter 1070 allows TDCI to contract with an external provider to administer and adjudicate these specialized claims.

In November 2022, TDCI issued a formal request for proposals to administer the external appeal process and help ensure pharmacies are paid at least their actual cost for prescription drugs and devices as defined in Tenn. Code Ann. §56-7-3206(h)(1). Myers and Stauffer LC was the successful bidder and was awarded the contract.

“By retaining an experienced contractor like Myers and Stauffer as the third party that oversees and administers appeals related to PBM reimbursement complaints, the Department is ensuring that the review and resolution of appeals will be handled with professionalism, fairness, and transparency,” said TDCI Commissioner Carter Lawrence.

To learn more about TDCI’s role in regulating PBMs, including pharmacy reimbursements, external appeals, or to file a complaint related to a PBM, visit us online.