Prior Authorization in Tennessee
Tennessee enacted SB 540 (2019) establishing step therapy exception requirements. The law provides exceptions for contraindications, prior treatment failures, and expected inefficacy. Tennessee requires PA decisions within 5 business days for standard and 24 hours for urgent.
Key Facts About PA in Tennessee
- ✓ Standard PA decisions required within 5 business days; urgent within 24 hours
- ✓ Step therapy exception requirements codified in law
- ✓ External review available through the TN Department of Commerce and Insurance
- ✓ BlueCross BlueShield of Tennessee is the dominant commercial carrier
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Tennessee
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Tennessee carriers:
BCBS of TennesseeUnitedHealthcareCignaAetna