Rules & Regulations of the State of Tennessee
Title 0780 - Commerce and Insurance
Subtitle 0780-01 - Insurance Division
Chapter 0780-01-95 - Pharmacy Benefits Managers
Section 0780-01-95-.02 - DEFINITIONS

(a) "Audit" means an examination by the Commissioner to determine the financial condition of, or legality of conduct by, a PBM pursuant to T.C.A. § 56-7-3101(b)(1)(A). This definition shall not apply to a PBM's audit of a pharmacy referenced in Rule 0780-01-95-.09 and Rule 0780-01-95-.15(1)(g).

(b) "Cash discount" means a deduction from the invoice paid by a pharmacy for a prescription drug or device if the invoice is paid on or before a specified date or in cash.

(c) "Commissioner" means the commissioner of the department of commerce and insurance or the commissioner's designee.

(d) "Control" has the same meaning as that term is defined in T.C.A. § 56-11-101(3).

(e) "Department" means the department of commerce and insurance.

(f) "Initial appeal" means the process required under T.C.A. § 56-7-3206(c)(2) and administered by a pharmacy benefits manager by which a pharmacy, or a pharmacy services administrative organization acting on behalf of a pharmacy, may appeal a reimbursement received from a pharmacy benefits manager that is not at least the actual cost to the pharmacy for a prescription drug or device.

(g) "MAC list" means a maximum allowable cost list as defined in T.C.A. § 56-7-3102.

(h) "Majority wholesaler" means the wholesaler from whom a pharmacy purchased the majority of its prescription pharmaceutical products for resale in the calendar year preceding the calendar year during which the claim that is the subject of an initial appeal is processed.

(i) "PBM" means a pharmacy benefits manager as defined in T.C.A. § 56-7-3102.

(j) "Pharmacy" means a pharmacy as defined in T.C.A. § 56-7-3102 and includes an agent acting on behalf of a pharmacy, including but not limited to a pharmacy services administrative organization.