Governor hits the road to promote his TennCare plan
JOHNSON CITY (AP) — Gov. Phil Bredesen began hearing suggestions Wednesday from doctors, nurses and other health professionals on how to fine-tune his proposed reform of TennCare at the Quillen School of Medicine.
While the care providers were generally positive and pleased that somebody is trying to revamp TennCare, they raised concerns about how Bredesen’s proposed benefit reductions would affect some patients.
“Many of my patients I honestly could not look at them and say ‘I can only give you six prescriptions a month,'” said Dr. Susan Sloan of the East Tennessee State University group of practicing physicians. “I think we’d be doing a great disservice to arbitrarily limit that number.”
Bredesen proposes limiting prescriptions to six per month for about a third of TennCare’s 1.3 million enrollees, part of a package of benefit limits he proposed to lawmakers Tuesday night. Bredesen’s reform package aims to limit TennCare spending to about 26 percent of the annual state budget. He estimates his changes could save $1 billion annually by 2008.
Most of the benefit reductions wouldn’t apply to pregnant women, children and the disabled — about 859,000 people — but Bredesen acknowledged limits, particularly on prescription drugs, are a difficult thing.
“With a really good physician who has total control of the patient’s care, a scrip limit shouldn’t be needed,” he said. “The problem is we’ve got people seeing eight or 10 primary care physicians and they’re all prescribing something.”
Bredesen met with about a dozen current and former TennCare enrollees Wednesday evening at the Dodson Avenue Community Health Center in Chattanooga. Most of the questions from the group had little to do with Bredesen’s proposed changes, although some worried about limiting prescriptions to six a month.
Shirley Hamil asked Bredesen if he had addressed what enrollees should do if they take more than six medicines each month.
The governor said Hamil didn’t get an answer yet “because I don’t have an answer for you.”
Bredesen said he hopes that those who need more than six prescriptions a month can make arrangements for TennCare to pick up the most expensive ones so they will be left to pay for the cheapest drugs.
He also got a brief lesson in alternative medicine while in Chattanooga. TennCare enrollee Thomas Barnes said he had a swollen saliva gland but a doctor would not give him a prescription.
“She told me to go home and eat pickles,” Barnes said. “Sure enough the pickles worked. That saved TennCare some money.”
“Write that one down,” Bredesen responded.
Earlier in Johnson City, Bredesen said he needs the help and expertise of the state’s medical community to fine-tune the TennCare reform.
But he stressed during the hour-long discussion that benefit increases must be offset with cuts elsewhere.
“I can’t wake up five years from now and discover that $1 billion (in projected savings by 2008) has become $500 million,” he said.
TennCare, the state’s health care program for the poor, disabled and uninsured, is budgeted at $7.8 billion next year, with two-thirds of the cost paid by the federal government.
Dr. Rebecca Powers of the ETSU group pointed to Bredesen’s proposal to remove antihistamines from the approved prescription drug list because over-the-counter alternatives are available. She said more children with allergies could develop asthma if parents can’t or won’t buy the nonprescription allergy drugs available.
“I know how far I’ve got to push in terms of money,” Bredesen said. “If you can make a more sensible set of recommendations, there’s a long way to go.” He also noted that in some circumstances, TennCare will pay for over-the-counter drugs.
“That may be an area where we need to loosen the reins a little bit,” he said. “But I want to be clear: When we do that we have to tighten them up somewhere else.”
The doctors also questioned if health problems could be caused by Bredesen’s proposal to try to force the use of cheaper alternatives to the two most prescribed drugs for TennCare patients— Zyprexa for schizophrenia and Zocor for high cholesterol.
“When it’s $5 for one alternative and 33 cents for the other, it demands this kind of discussion,” Bredesen responded, referring to the price difference between Zyprexa and the generic alternative. “We need to be a purchaser trying to make some decisions about where the good trade-offs are.”
Dr. Jeff Hopland of Elizabethton said he could end up in court if TennCare tells him he cannot prescribe Zyprexa for his patients and he uses another drug that induces side effects, or does not control the patient’s illness
“I get sued because that’s not the standard of care. There needs to be some protection from a legal standpoint,” Hopland said.
Bredesen nodded vigorously. “I understand,” he said. “It’s one of the issues we have to deal with.”