This notice is being sent to notify you of changes for the TennCare pharmacy program. We encourage you to read this notice thoroughly and contact Magellan’s Pharmacy Support Center (866-434-5520) should you have additional questions.

Removal of agents from list of branded agents classified as generics

Effective November 1, 2016, the following agents will be moved to non-preferred status on the TennCare PDL and will be removed from the list of branded agents classified as generics meaning that they will now count as a brand toward members’ monthly prescription limits and copays.

*Please see attached PDF for more information.

Addition of Maximum Allowable Cost (MAC) Pricing to Diabetic Supplies Magellan Medicaid Administration implemented a new MAC to all lancets effective August 24, 2016. Additionally, all other diabetic supplies will be subject to MAC pricing effective September 5, 2016. Please make a note of the new pricing below to ensure that you are purchasing and billing for the lowest cost alternative for these supplies.

This notice is being sent to notify you of changes for the TennCare pharmacy program. We encourage you to read this notice thoroughly and contact Magellan’s Pharmacy Support Center (866-434-5520) should you have additional questions. PREFERRED DRUG LIST (PDL) FOR TENNCARE EFFECTIVE 10-1-16 TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL may occur as new classes are reviewed and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. A copy of the new PDL will be posted October 1, 2016 to https://tenncare.magellanhealth.com. We encourage you to share this information with other TennCare providers. The individual changes to the PDL are listed below. For more details on clinical criteria, please visit: https://tenncare.magellanhealth.com

To: All TennCare Ambulatory Pharmacy Network Providers Re: Coverage of up to a 91-day supply of insulin products The purpose of this notice to TennCare pharmacy providers is to clarify the intent of the coverage of up to a 91-day supply of insulin products. On March 29, 2016, Tennessee Code Annotated, Title 63, Chapter 10, Part 2 was amended allowing a pharmacist to "exercise professional judgment to dispense varying quantities of medication per fill up to the total number of dosage units as authorized by the prescriber on the original prescription including any refills, so long as the units dispensed do not exceed a ninety-day supply". Although pharmacists are allowed by Tennessee Law to fill prescriptions for maintenance medications up to a 90-day supply, TennCare still only covers 31 days supply due to the frequent change in eligibility status of our enrollees. For insulin products, please note that we allow up to a 91-day supply because of the fact that insulin doses and regimens are individualized, and in many cases, a single bottle of insulin cannot be used by a patient within a 31- day timeframe. Due to individualized dosing, and the inability to break a 10ml vial package, we allow up to a 91- day supply. At the same time, pharmacists should not automatically provide a 90-day supply simply because the law allows this. TennCare still covers only the least costly amount of the drug necessary to meet the doctor’s prescription.