As used in this part, unless the context otherwise requires:

(1) “Actual reimbursement” means the total amount that a covered entity or pharmacy benefits manager determines that a pharmacy or other dispenser will receive consistent with the provider agreement, and is the sum of the amount the covered entity or pharmacy benefits manager will pay directly to the pharmacy or other dispenser plus any applicable patient out-of-pocket cost paid directly by the patient to the pharmacy or other dispenser, for dispensing of a particular prescription or providing a covered service;

Terms Used In Tennessee Code 56-7-3201

  • Covered entity: means a covered entity as defined in §. See Tennessee Code 56-7-3201
  • Pharmacy benefits manager: means a pharmacy benefits manager as defined in §. See Tennessee Code 56-7-3201
  • Prescription drug: means a drug that under federal or state law is required to be dispensed only pursuant to a prescription order or is restricted to use by individuals authorized by law to prescribe drugs. See Tennessee Code 56-7-3201
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
(2) “Cost sharing requirement” means a copayment, coinsurance, deductible, or annual limitation on cost sharing, including, but not limited to, a limitation subject to 42 U.S.C. §§ 18022(c) and 300gg-6(b), required by, or on behalf of, an enrollee in order to receive a specific healthcare service covered by a health plan, including a prescription drug, whether under the medical or the pharmacy benefit;
(3) “Covered entity” means a covered entity as defined in § 56-7-3102;
(4) “Generic alternative” means a drug that is designated to be therapeutically equivalent by the United States food and drug administration’s Approved Drug Products with Therapeutic Equivalence Evaluations;
(5) “Pharmacy benefits manager” means a pharmacy benefits manager as defined in § 56-7-3102; and
(6) “Prescription drug” means a drug that under federal or state law is required to be dispensed only pursuant to a prescription order or is restricted to use by individuals authorized by law to prescribe drugs.
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