August 24, 2016
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.