This memo provides clarification regarding previous correspondence sent to TennCare Pharmacy Network Providers regarding circumstances in which a provider is unable to fill a prescription for an enrollee because:

• The pharmacy has chosen not to carry a particular drug or class of drugs; or
• In the professional judgment of the pharmacist, the prescribed medication should not be dispensed to the enrollee.

TennCare views its relationship with participating pharmacists as a mutually-beneficial and important partnership. Pharmacies and pharmacists provide our members with valuable and essential services. Additionally, the exercise of your professional judgment in filling prescriptions for our members plays a vital role in the State of Tennessee’s larger fight against control substance abuse and/or over utilization.

While TennCare values the independent, professional judgment of each of its pharmacist partners and respects the business decisions made by its pharmacies, we also have a responsibility to assure our members have access to medically necessary medications. This is especially critical in the case of members who are locked in to a particular pharmacy since these individuals cannot simply go to an alternative pharmacy if they are unable to fill a prescription.

To address these occasionally (though rarely) competing interests, TennCare required Magellan to include contract language in the TennCare provider contract specifically deferring to pharmacist judgment and providing each pharmacy with an administratively non-burdensome way to stop serving a TennCare member. Pharmacists should utilize this process when, in the exercise of the pharmacist’s professional judgment, an enrollee’s full spectrum of pharmaceutical needs cannot be served by the pharmacy. This will provide TennCare with the opportunity to assess the situation and identify alternative options to address any unmet member need.

Thank you, again, for all you do and for your hard work in partnering with TennCare to ensure that medically necessary, covered pharmaceutical services are readily available to our members throughout this state. I look forward to continuing TennCare’s long and successful partnership with each of you in the coming years. In the event that I or any of my staff can be of assistance to any of you in the future or answer any of your questions that may remain outstanding even after this communication, please do not hesitate to contact me at (615) 507-6415 or at james.hailey@tn.gov.