The Tennessee Department of Commerce and Insurance (DCI) recently issued four consent orders for failing to comply with PBM laws. DCI fined ESI $250,000 for twelve violations, including failure to pay enhanced dispensing fees to low-volume pharmacies; paying affiliated pharmacies more than non-affiliated pharmacies; not paying actual acquisition cost even after appeals; performing pharmacy audits within the first seven days of the month; and making illegal recoupments. Meanwhile, DCI issued three fines of $250,000 each to Caremark entities for not reporting required information related to MAC lists, networks, external appeals, claims, and audits.
Caremark asked for, and was granted, multiple extensions but still failed to comply. Under Tennessee law at the time of these violations, $250,000 was the maximum allowable fine. With the enactment of H.B. 1244 earlier this year, which removed the cap on fines effective May 2025, similar consent orders will be accompanied by larger fines in the future.
