Pharmacists predict chaos as TennCare changes kick in
Confusion over coverage loss,
prescription limits may lead to waits for all
bracing for major changes in TennCare drug policies that will
directly affect about 700,000 people across the state beginning
Some will lose
TennCare drug coverage entirely, while others will face new limits
on the number and types of prescriptions they can fill.
pharmacists say they are being swamped with calls and visits from
TennCare enrollees — many of them confused — asking which drugs they
need most or how to get drugs elsewhere. The pharmacists predict
"utter chaos" at state pharmacies when they open for business Monday
morning, and warn that all customers — including those not on
TennCare — may face extra drugstore waits for weeks to come.
pharmacy director David Beshara says state officials have worked to
make sure everything that can go smoothly will.
definitely a little bit of a learning curve with all the changes,"
Beshara said. "But we've been working very hard with all the
pharmacists in the state to make the transition as easy as
drug changes are a major piece of Gov. Phil Bredesen's plans to
overhaul the financially troubled public insurance plan for the
poor, elderly and disabled.
The governor has
cited the high cost and high usage rates of prescription drugs in
TennCare as the program's biggest problem.
As things stand
now, the changes taking place Monday will include:
• TennCare will
stop paying for prescriptions for about 290,000 people.
About 190,000 of
these will have access to "safety net" drugs being offered by the
state through drug discounts and free generics.
97,000 of those deemed "medically needy" — and described by Bredesen
as the "sickest" on TennCare — will lose drug coverage altogether on
Monday. They will not have access to the discount and generic drug
plans being offered to others cut from TennCare, according to Lola
Potter, spokeswoman for the Department of Finance and
Administration, which oversees TennCare.
She said the
state hoped to get concessions in a federal court lawsuit that would
prevent this from happening.
400,000 people will face a cap on their monthly drug benefit. They
will be entitled to no more than five prescriptions per month. Of
those, no more than two can be brand-name drugs and the rest must be
generic. Additionally, there is a so-called "short list" of drugs
exempted from this rule that are used to treat such things as
hepatitis C, kidney failure and hemophilia.
that will begin Monday include an end to prescriptions for
over-the-counter drugs for most people and the elimination of
methadone services, adult dental care, some at-home nursing care and
convalescent care in nursing homes for those leaving hospitals.
as Ferrell Haile of Perkins Drugs in Gallatinarepredicting that the
drug changes will create chaos and confusion.
"I think it's
going to be utter chaos," he said. "I don't mean to be funny. I
think it's going to be total chaos. It's not just going to be a day
or two. It's going to be a month or six weeks of total chaos."
going to have to spend so much time working with TennCare enrollees
to straighten out their drug regimen, and to find additional drugs,
that normal business operations will be thrown off, he said.
already seen the effects of the impending changes in his small
Gallatin pharmacy. About a third of the patients he sees are
TennCare enrollees. In recent days, the pharmacy hasbeen getting up
to 50 inquiries a day from people facing TennCare drug changes and
wondering what to do next.
Haile's partner, Sam Rickman, talked through the changes with a
longtime customer at the pharmacy's drive-through window. Rickman
offered to give the man a computer printout of the prescriptions he
regularly fills to take to his doctor, so the doctor could determine
which could be substituted with generic drugs and which were least
expensive and could be paid for out-of-pocket.
"We can do all
this work, looking at their drug regimen and contacting their
physicians, but all of that takes time and energy," Haile said. "On
top of that is the lack of understanding about what's taking place,
and why someone has to switch from one pill to another one. When you
have to have six to seven pills to survive, there's going to be
are concerned about changes to computer systems operated by a
TennCare contractor, said Baeteena Black, executive director of the
Tennessee Pharmacy Association. The computers are critical, she
said, to helping pharmacists determine whether someone can still get
drugs under TennCare, or whether that customer has reached the
happening August 1 is going to require significant systems changes
and we do not know, and will not know, how smoothly things are going
to happen" until the system goes into place midnight Monday, she
that the system had been well-tested and that he expected no
But even if
things run smoothly, Black said, pharmacists probably will be
overwhelmed by the needs of people affected by the drug changes. "My
real concern is just the fact that, as willing as pharmacists are
going to be on August 1, there's no way they're going to be able to
solve all these problems. And it's going to affect all their
The state has
plans to provide additional drug assistance.
190,000 people losing coverage, the state is providing a $57 million
"safety net" drug program. Discount drug cards have been mailed to
everyone being cut from TennCare, and access to a mail-order program
that gives away free generic drugs from a list of 55 is also
available. Already, about 2,000 orders have been placed for the
generic drugs, averaging a request of three apiece, Potter said
The state is
still trying to find a solution for the 97,000 "medically needy"
TennCare enrollees, Potter said. These are people with medical bills
so high that they would be impoverished without assistance.
The governor has
said he hopes to keep them on TennCare if he can win approval of
cost-saving measures in federal court. They would then have the same
capped drug benefit as other adults on TennCare.
lawyers are trying to stop the limits from going into place
in a federal court case involving drug and other benefit limits are
to take place today.
say the prescription drug cap has been approved by the federal
government and will not require a change in current legal