Tennessee access to Public Records Act Request: Request for Prescription Claims Data

Brenda Addis-Burke filed this request with the Division of TennCare of Tennessee.
Status
Awaiting Acknowledgement

Communications

From: Kent Hoover


To Whom It May Concern:

Pursuant to the Tennessee Public Records Act, I hereby request the following records:

To Whom It May Concern:

Pursuant to the Freedom of Information Act, I hereby request the following records:

Claims data is used by the state to determine Medicaid Drug Rebate Program(“MDRP”), State Pharmaceutical Assistance Program (“SPAP”),and Aids Drug Assistance Program (“ADAP”) rebate-eligible units. These data are likely provided to the state’s rebate vendor, OptumRx, who uses these data when invoicing drug manufacturers for rebates.

Pharmaceutical manufacturers engage Kalderos to assist them with performing "audits" of Medicaid claims data used by states such as Tennessee for determining Medicaid Drug Rebate Program rebates due to the state. This "audit" right is granted to drug manufacturers as part of the Medicaid Drug Rebate Program statute [See https://www.law.cornell.edu/uscode/text/42/1396r-8] as well as under the rebate agreement entered into with the HHS Secretary [see https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/downloads/samplerebateagreement.pdf]
Kalderos has been granted authority by its clients (pharmaceutical manufacturers) to obtain claims level data on their behalf. As such, we respectively request Indiana to provide responsive data and responsive data elements to enable us to perform validation tests on behalf of our clients. We will provide letters from our drug manufacturer clients granting us such authority upon request. We will be happy to work with state personnel to define exactly which data attributes are responsive and data delivery methods that work for both parties (such as secure FTP).

The state’s rebate vendor, OptumRx, suggested that we initiate a request under the state’s open records law to obtain the data we need. Kalderos’ interaction with OptumRx has been with Ashley Norvall, Sr. Rebate Analyst, Industry Relations OptumRx. Ashley.Norvell@optum.com 1-404-267-6615

The time period we request claims data is for rebate quarters 2020Q1. Please note that our request for data will be ongoing on a quarterly basis, and we desire to work out an arrangement with the state for providing data in a systematic and recurring basis.

This request is being made for commercial purposes.

In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.

Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 7 business days, as the statute requires.

Sincerely,

The requested documents will be made available to the general public, and this request is not being made for commercial purposes.

In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.

Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 7 business days, as the statute requires.

Please note that I am a citizen of Tennessee, and am using MuckRock's services to help manage and track my request.

Sincerely,

Kent Hoover

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