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2004 Tennessee Attorney General Reports and Opinions 1 (2004)

handle is hein.sag/sagtn0002 and id is 1 raw text is: STATE OF TENNESSEE OFFICE OF THE ATTORNEY GENERAL PO BOX 20207 NASHVILLE, TENNESSEE 37202 January 6, 2004 Opinion No. 04-001 Pharmacy Benefits under State and Local Government Health Plans QUESTIONS 1. a. Does Tenn. Code Ann. § 56-7-2359, the any willing pharmacy statute, apply to the state insurance committees administering the state health plan for state, local, and local education employees (the State Plans)? b. Would the state insurance committees have violated Tenn. Code Ann. § 56-7-2359 if they created different non-economic terms and conditions (such as hours of service) for mail-order pharmacy benefits as opposed to retail pharmacies to provide benefits for these health plans? 2. Under the State Plans for 2004 as implemented, a participant who uses a retail pharmacy for maintenance medication must make a separate co-payment for each thirty-day supply. A participant who orders maintenance prescription drugs from a mail-order service, by contrast, makes only a single co-payment for a ninety-day supply. Does this different treatment violate Tenn. Code Ann. § 56-7-117? 3. Does an employee health plan by the City of Memphis or any other local government that requires participants to obtain maintenance medication from a mail-order pharmacy violate either Tenn. Code Ann. § 56-7-117 or Tenn. Code Ann. § 56-7-2359? OPINIONS 1. No, Tenn. Code Ann. § 56-7-2359 cannot reasonably be interpreted to apply to the state insurance committees when defining the benefits for the State Plans. Because of our answer to Question 1.a, Question 1.b is moot. 2. By its terms, Tenn. Code Ann. § 56-7-117 applies to listed entities that are regulated under different provisions of state law. Because the state insurance committees are not regulated under any of these statutory schemes, this statute does not apply to them when they are defining the benefits for the State Plans.

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