Duty of Pharmacy Benefits Manager — Health Insurance Under Tenncare Program

1. Law
2. Tennessee Code
3. Insurance
4. Policies and Policyholders
5. General Provisions
6. Duty of Pharmacy Benefits Manager — Health Insurance Under Tenncare Program

1. A pharmacy benefits manager shall notify a pharmacist who furnishes goods or services under any policy or contract for health insurance coverage provided under the TennCare program of the failure of any health insurer to provide timely payments for nondisputed claims pursuant to contract within fourteen (14) days of the failure of the health insurer to fund a scheduled payment.
2. Failure by a pharmacy benefits manager to provide notice as described in subsection (a) shall be cause for the commissioner to impose the appropriate penalties allowed in this title.
3. As used in this section, “pharmacy benefits manager” means a person, business or other entity and any wholly or partially owned subsidiary of the entity, that administers the prescription drug or device portion of plans providing health insurance coverage on behalf of a third party, including plan sponsors, insurance companies, unions, and health maintenance organizations.

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