Pharmacy Benefit Managers

Pharmacy Benefits Manager Reimbursement Appeals

Tennessee pharmacy providers may appeal their reimbursement from pharmacy benefit 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.

Appeal Reimbursement

The Department made the form accessible via this website to every PBM and covered entity pursuant Tennessee Code Annotated 56-7-3206(c)(2)(D). Pharmacies and entities appealing on their behalf must be allowed to use this standardized form.

The standardized form to file an appeal with the PBM can be accessed here: Standard Pharmacy Reimbursement Appeal Form.

External Appeals

Pursuant to Tennessee Code Annotated 56-7-3206(g)(2), the Department has established an external appeal process to review initial appeals conducted by pharmacy benefits managers. To file an external appeal, please review Rule 0780-01-95-.06 and submit the Standard Pharmacy Reimbursement Appeal Form to PBM.Compliance@tn.gov.

File a Complaint

Tennessee pharmacy providers may also use this website to file formal complaints about pharmacy benefit managers.

The form to file a formal complaint can be accessed here: Pharmacy Benefit Manager Complaint Form.