Tennessee Department of Commerce and Insurance

Pharmacy Benefit Manager External Payment Appeals

Myers and Stauffer LC is the contractor responsible for administering the external appeal process for the review and resolution of appeals by pharmacies challenging payments made by pharmacy benefit managers (PBM) that were not paid at the pharmacy’s actual cost as defined in Tenn. Code Ann. §56-7-3206(h)(1). For a list of excluded PBM/health plan combinations, please reference the Excluded PBMs and Health Plans document at the bottom of this page.

Pursuant to Tenn. Code Ann. §56-7-3102(1)(B), the following plans are excluded from the External Appeals process.

(i) A health plan that provides coverage only for accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, or other long-term care; or
(ii) A plan subject to regulation under Medicare part D;”

Contact Information

Myers and Stauffer
Hours: 8am — 8pm ET, Mon-Fri
Phone: 800.591.1183
Email: TNPBMAppeals@mslc.com
Fax: 317.815.2971

Email: PBM.Compliance@tn.gov
Website: TDCI PBM Website

External Appeal(s) Submissions

For detailed information on the external appeals process and submission requirements, please reference the PBM External Payment Appeals Guide at the bottom of this page.

Submission Methods

To submit an appeal, pharmacies, or those submitting on behalf of pharmacies can use the button to the right to submit an online form or use one of the following methods:

  1. U.S. Postal Mail:
    ATTN: TN PBM Pharmacy Appeals
    800 E. 96th St., Suite 200
    Indianapolis, IN 46240
  2. Fax:
    ATTN: TN PBM Pharmacy Appeals

Bulk Appeals

To submit bulk appeals online, pharmacies must complete the bulk submission template below, go to the online submission form above, select the bulk appeals option, and upload the completed template within the supporting documentation section. To submit bulk appeals via US Postal Mail or Fax, pharmacies must include BOTH the fillable appeal form and bulk submission template with their submission.

NOTE: Bulk submissions can be submitted for multiple claims and drugs but they must be unique to one provider location (NPI), PBM, BIN, PCN, and Rx Group number.