Some say TennCare drug limit harming patients

Before the cuts began Aug. 1, TennCare provided unlimited prescription coverage, but that has been cut to paying for two name brand and three generic drugs per month for adults not among the approximately 97,000 classified at “medically needy.”

“The state is saving money, but it’s at the expense of the health of patients,” said Phil Bradley, owner of Bradley Drug Co. in Nashville. “Five prescriptions a month takes care of a lot of people, but it does not take care of that percentage of the population that has multiple diagnoses.”

Burton West, a doctor in Newport, said a 64-year-old patient has had to be hospitalized since having his prescriptions limited.

“He was admitted twice since then, which largely can be blamed on running out of the medicines that he had been prescribed earlier,” West said.

The state had sought for months to win approval for the cuts, which Gov. Phil Bredesen said are necessary to slow growth of TennCare costs and avoid crippling cuts to other state services.

Federal Medicaid officials gave their approval, but advocates for TennCare fought the cuts in the federal courts. U.S. District Judge John Nixon removed the final hurdles in July, and the changes have been implemented since last month.

West said he supports TennCare reform, but that its current structure hurts some.

“I basically support the idea of limiting the expense the state has on health care because we need to educate children, for example, too,” West said. “I am in agreement with the governor in this general, large point, but the way this is being interpreted, or the way it is set up, is harmful for people with new, additional diagnoses.”

Jim Schulman, who oversees the state’s so-called “safety net” of health care services available for people whose TennCare benefits were cut or reduced, said the state has tried to limit harm to patients.

He said the state has created a list of drugs exempt from the prescription limit.

There may also be an opportunity in the future to add flexibility to prescription limits based on need, officials said.

TennCare spokeswoman Marilyn Elam said state officials favored a “soft limit” on drugs based on need, but that the court challenges had made that impossible.

Paula Wade, spokeswoman for the Tennessee Justice Center, which fought to preserve benefits for TennCare enrollees, said her organization is a scapegoat for state officials addressing complaints about the cuts.