House approves bill creating single drug list for TennCare
NASHVILLE — The House overwhelmingly approved on Thursday legislation that would limit prescription drug options for TennCare patients — and perhaps eventually for government employees, inmates and children in state custody.
Doctors in Tennessee currently must deal with up to 10 different health plans, each with different lists of approved drugs, said Rep. David Shepard, D-Dickson.
‘It’s a headache and a nightmare. This bill will remedy the TennCare part of that nightmare,’ said Shepard, a pharmacist who sponsored the ‘preferred drug list’ legislation.
The bill also would save at least $150 million during the next fiscal year, in part through rebates from pharmaceutical manufacturers.
‘My feeling is that estimate is low. Once we’ve instituted this program, we will have something we can all be proud of. It will remove pharmacy’s high cost from the problems,’ Shepard said.
Without changes to TennCare, the state faces a huge shortfall in the state-federal health care program next year, and escalating drug costs are a large part of the problem. Shepard said drugs constitute 28 percent of TennCare’s cost, which is $7 billion in Gov. Phil Bredesen’s budget for next year.
The legislation, sent to the Senate on a 93-2 vote, would create a 15-member TennCare pharmacy advisory committee that includes pharmacists, doctors, a representative of a TennCare managed care organization and an advocate for enrollees.
That committee would submit to TennCare recommended drugs to be included on a preferred drug list, or PDL for short. The TennCare bureau would develop a prescription drug program and contract with at least one pharmacy benefit manager to set pharmacy reimbursement rates, negotiate rebates with manufacturers and the like.
Currently, each of TennCare’s nine managed care organizations has its own preferred drug list, and they vary among the different plans. Each MCO also has its own pharmacy benefits manager, which adds another layer of administrative costs.
The legislation also allows for the creation of tiered co-payments from TennCare enrollees — based on their ability to pay — and would allow the bureau to require prior authorization for certain drugs.
However, it does address the industry’s concerns about preserving patient access to certain medications, sponsors said.
The legislation would initially apply only to TennCare, but could be expanded to the state’s health care plan for its employees, and for people in state custody.
Shepard said it could also allow the state to set up a drug assistance program for senior citizens similar to one in Maine.
‘I see problems in it every day in my drug store where people cannot buy medicine because it is too expensive,’ he said.
Brian McGuire, legislative director for the Tennessee AARP, said the bill ‘sets up a structure for an affordable drug benefit within TennCare, but more importantly it sets up the ability to expand coverage for people on Medicare and other low income folks that need help with their prescription drugs.’
Voting against the bill were Reps. Henri Brooks, D-Memphis, and Joe Armstrong, D-Knoxville. Armstrong narrowly failed to get the House to expand the committee membership to include at least two lawmakers.
‘We need some type of legislative input. We need to be part of the process. We’re the policy-making body,’ Armstrong argued.
But House Democratic Leader Kim McMillan said lawmakers were deliberately excluded in hopes of keeping politics out of the decisions on which drugs should be on the list. The House voted 55-38 to table the amendment, meaning that they refused to consider it.
The bill was the result of months of work among lawmakers, the Bredesen administration, pharmacists, health care providers and others.
Even if the bill doesn’t pass, Bredesen will create a PDL administratively. His proposed budget for next year is predicated on savings of at least $78 million in state dollars with such a list.
———
The bill is HB1650/SB1371.
———
On the Net:
TennCare Bureau: http://www.state.tn.us/tenncare