Information to Be Provided Regarding Maximum Allowable Cost Lists — Updating Maximum Allowable Cost Lists

1. Law
2. Tennessee Code
3. Insurance
4. Policies and Policyholders
5. Pharmacy Benefits Managers
6. Information to Be Provided Regarding Maximum Allowable Cost Lists — Updating Maximum Allowable Cost Lists

1. A pharmacy benefits manager or covered entity shall make available to each pharmacy with which the pharmacy benefits manager or covered entity has a contract and to each pharmacy included in a network of pharmacies served by a pharmacy services administrative organization with which the pharmacy benefits manager or covered entity has a contract, at the beginning of the term of a contract and upon renewal of a contract:
   1. The sources used to determine the maximum allowable costs for the drugs and medical products and devices on each maximum allowable cost list;
   2. Every maximum allowable cost for individual drugs used by that pharmacy benefits manager or covered entity for patients served by that contracted pharmacy; and
   3. Upon request, every maximum allowable cost list used by that pharmacy benefits manager or covered entity for patients served by that contracted pharmacy.
2. A pharmacy benefits manager or covered entity shall:
   1. Update each maximum allowable cost list at least every three (3) business days, as required by § 56-7-3104(b);
   2. Make the updated lists available to every pharmacy with which the pharmacy benefits manager or covered entity has a contract and to every pharmacy included in a network of pharmacies served by a pharmacy services administrative organization with which the pharmacy benefits manager or covered entity has a contract, in a readily accessible, secure and usable web-based format or other comparable format or process; and
   3. Utilize the updated maximum allowable costs to calculate the payments made to the contracted pharmacies within five (5) business days.

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