(a) As used in this section, unless the context otherwise requires:
Terms Used In Tennessee Code 71-5-155
Contract: A legal written agreement that becomes binding when signed.
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
(1) “Bureau” means the bureau of TennCare;(2) “Collaborative pharmacy practice agreement” has the same meaning as defined in § 63-10-204;(3) “Medication therapy management pilot program” means the test program established by the bureau of TennCare meeting the definition of the term “medication therapy management program” in § 63-10-204; and(4) “Medication therapy management services” means the provision of direct patient care services by a pharmacist licensed under title 63, chapter 10 practicing in this state, to optimize the therapeutic outcomes of the patient’s medications. Medication therapy management encompasses a broad range of professional activities and responsibilities within the licensed pharmacist’s scope of practice. Medication therapy management services are independent of, but can occur in conjunction with, the provision of a medication product.(b)(1) The bureau shall develop and implement a medication therapy management pilot program that seeks to provide high quality, cost-effective services in support of initiatives administered by the bureau to ensure optimal health outcomes for TennCare beneficiaries.(2) Any managed care organization or pharmacy benefit manager that participates in the TennCare medication therapy management pilot program, as determined by the bureau, shall administer a medication therapy management pilot program that meets the program standards and eligibility criteria as established by the bureau.(c)(1) The bureau shall establish program standards and eligibility criteria for the medication therapy management pilot program. Eligibility criteria may include use of specific medications, use of classes of medications, disease states, health conditions, mental health conditions, complex medical and drug-related needs, and other clinical factors, as determined by the bureau.(2) Medication therapy management services shall be delivered by a participating qualified Tennessee-licensed pharmacist, as determined by the bureau, acting under a collaborative pharmacy practice agreement meeting the requirements of § 63-10-217 and within the routine scope of the practice of pharmacy, as defined in § 63-10-204, and in consultation with patients, caregivers, prescribers, and other healthcare providers, as appropriate. Technical responsibilities related to medication therapy management services, other than the delivery of direct patient care services, such as obtaining accurate medication histories and records, scheduling visits, documentation, and billing for services, may be delegated to pharmacy technicians and other pharmacy personnel at the discretion of the pharmacist responsible for delivering the service.(3) Nothing in this section shall expand or modify the scope of the practice of pharmacy as defined in title 63, chapter 10, part 2.(d)(1) The bureau shall establish reimbursement rates for medication therapy management services provided by pharmacists under a collaborative pharmacy practice agreement within the medication therapy management pilot program.(2) For purposes of reimbursement for medication therapy management services, the bureau, or its managed care organizations, may enroll individual pharmacists as providers under their medicaid provider program. The bureau may also establish contract requirements necessary to implement the pilot program.(e) Any cost savings realized by the bureau through administration of the medication therapy management pilot program shall be prioritized for use in expanding the administration of the medication therapy management pilot program. Any expansion of the pilot program shall be determined by the bureau upon conclusion of the pilot program and after evaluation of the pilot program to determine overall impact to the program in terms of cost-effectiveness and medical outcomes.(f) As part of the pilot program, the bureau may seek input from pharmacists, primary care providers, or other key stakeholders to provide technical assistance in the development and implementation of the bureau’s medication therapy management pilot program.(g) The medication therapy management pilot program shall terminate on June 30, 2020.
