Tennessee

Tennessee was the 17th state to pass DPC legislation on 04/27/16. DPC practices were already in operation in Tennessee, and now the state is a better environment for DPC physicians.  The folks at the Beacon Center of Tennessee prepared a helpful overview of DPC for members of the state legislature that led to the passage of HB 2323 (see this link for legislative history).  The law (found in Tenn. Code Ann. §§ 63-1-501 through 63-1-504) has an excellent definition of DPC and is one of the best examples of state legislation.  Be sure to review the Tennessee Insurance Code (from Justia) when planning your DPC practice.

Physician Dispensing is permitted in Tennessee under the Rules of the Tennessee Board of Medical Examiners see Section 0880-2-.14 Specially Regulated Areas and Aspects of Medical Practice Pages 38-46. “Physicians who elect to dispense medication for remuneration must comply with the following: (a) All Federal Regulations (21 CFR 1304 through 1308) for the dispensing of controlled substances. (b) Requirements for dispensing of non-controlled drugs are as follows:

“1. Drugs are to be dispensed in an appropriate container labeled with at least, the following: (i) Patient’s name. (ii) Date. (iii) Complete directions for usage. (iv) The physician’s name and address (v) A unique number, or the name and strength of the medication. 2. Physicians may dispense only to individuals with whom they have established a physician/patient relationship. It shall be a violation of this rule for a physician to dispense medication at the order of any other physician not registered to practice at the same location. 3. Whenever dispensing takes place, appropriate records shall be maintained. A separate log must be maintained for controlled substances dispensing.”

Similarly see Tenn. Comp. R. & Regs. 1000-04-.09 “(4) Advanced Practice Nurses having proper authority to prescribe, who elect to dispense medication for remuneration must comply with all Federal Regulations ( 21 CFR 1304 through 1308 ) for the dispensing of controlled substances.”

“(5) Non-controlled drugs are to be dispensed in an appropriate container labeled with at least, the following:
(a) Patient's name.
(b) Date.
(c) Complete directions for usage.
(d) The name and address of the Advanced Practice Nurse having proper authority to prescribe.
(e) A unique number, or the name and strength of the medication.

(6) Whenever dispensing takes place, appropriate records shall be maintained. A separate log must be maintained for controlled substances dispensing.

(7) Whenever prescribing takes place, written or electronic prescription orders shall be prepared pursuant to T.C.A. § 63-7-123(b) (3).

(8) It is not the intention of this Rule to interfere with the individual Advanced Practice Nurses, having proper authority to prescribe, and their appropriate use of professional samples, nor is it to interfere in any way with the rights of Advanced Practice Nurses, who have proper authority to prescribe, to directly administer drugs or medications to any patient.”

Physician Assistant dispensing status is unclear. SB1171 and HB1272 offered in 2023 would have clarified that this was permitted, but they were not enacted.

Tennessee has this helpful language clarifying that private contracts are favored between patients and physicians. In the same legislative session the legislature passed some misguided buprenorphine regulations are that do interfere with private contracting in Tennessee. Physicians are not permitted to privately contract with Medicaid patients and prescribe this medications.

TN Code 63-1-503. Purchase and payment of medical services or products outside of insurance plan or outside of TennCare or Medicare program not prohibited.
(a)(1) Nothing in state law prohibits a patient or a legal representative of a patient from seeking care outside of an insurance plan, or outside of the TennCare or Medicare program, and paying for that care. (2) Nothing in state law prohibits a medical care provider licensed under this title, or a healthcare facility, licensed under title 33 or 68, from accepting payment for services or medical products outside of an insurance plan. (3) Nothing in state law prohibits a medical care provider licensed under this title, or a healthcare facility, licensed under title 33 or 68, from accepting payment for services or medical products provided to a TennCare or Medicare beneficiary.
(b) A patient or legal representative does not forfeit insurance benefits, TennCare benefits, or Medicare benefits by purchasing medical services or medical products outside the system.
(c) The offer and provision of medical services or medical products purchased and provided under this part is not an offer of insurance and is not regulated by the insurance laws of this state.