Tennessee drops plan to limit TennCare prescription drugs

NASHVILLE, Tenn. (AP) — Tennessee is dropping plans to make major changes to drug benefits in its Medicaid program after federal health officials raised concerns.

TennCare, Tennessee’s Medicaid program, said it would drop a proposal to impose limits on certain prescription drugs following pressure from the federal government. Last year, the state received approval from former President Donald Trump’s administration for an overhaul of TennCare that included the change. Officials argued the overhaul could produce flexibility and savings that would then fuel additional health coverage offerings, including prescription drug limits aimed at driving up costs.

But advocacy groups have expressed concerns that the change would limit low-income patients to one drug per therapeutic class and thus hinder access to certain drugs.

Advocacy groups have also argued that prescription drug limitations, known as closed formulary, may have violated an agreement under a Medicaid reimbursement law. Last month, the Biden administration asked the state to drop the idea and further modify TennCare’s block grant plan.

Alisa LaPolt speaks at a public hearing regarding Tennessee's application for a block grant for Medicaid.  Tuesday, October 1, 2019, in Nashville, Tenn.

The block grant plan has raised concerns among various groups of doctors and patients about how it could impact the care of the state’s most vulnerable patients. The backlash from the block grant has prompted questions about whether President Joe Biden would outright increase the program, which received federal approval just before the elder Trump left office.

TennCare said it also plans to implement the federal agency’s recommendations, including clarifications to show nothing in the plan “allows the state to reduce coverage or benefits” and to show that the State will use the savings to expand coverage.

Stephen Smith, director of TennCare, said in a statement that the agency is “encouraged” by the continued support of the federal Centers for Medicare and Medicaid Services and that the policy refinement process “is an important step in consolidating of providing high quality, cost effective care to our members.

The process is open for public comment until August 19.

The changes have drawn positive reviews from some advocacy groups.

Jeff Strand, governmental and external affairs coordinator for the Tennessee Disability Coalition, said it was “encouraging” to see TennCare address the concerns of federal officials and the public.

Tennessee Justice Center attorney Gordon Bonnyman called the changes “a step in the right direction,” but said concerns remained, including the lack of retroactive coverage for many Tennessees who may become eligible due to an accident or illness. , Bonnyman said retroactive coverage is now available for pregnant women and people under 21. He said it should be extended to all TennCare adults.

Tennessee lawmakers passed a resolution in 2019 calling for a block grant plan to be submitted for federal consideration. They argued that the existing system provided little incentive for states to control spending because no state pays more than half of the total cost.

Democrats and health care advocates have expressed concern that spending caps could cause states to purge their roles or cut services, which officials from Republican Gov. Bill Lee’s administration have said. they wouldn’t. Democrats and advocates instead want to expand Medicaid eligibility, something Republican leaders in Tennessee have refused to do under former President Barack Obama’s health care law. TennCare officials suspended the possibility of expanded eligibility under the block grant, but did not guarantee they would pursue it.

Lee said in January 2021 that Tennessee had become the first state in the nation federally approved to receive block funding for its Medicaid program through a block grant program.

The Tennessee Justice Center filed a lawsuit in federal court, seeking a halt to the block grant campaign.

Biden has so far refused to halt the initiative, instead opening it up to additional public comment last summer. This decision led to a break in the trial. The federal agency then sent the state its list of concerns about the details of the block grant last month. The agency said it was “evaluating a range of actions” while asking the state to make changes.

TennCare noted hundreds of millions of dollars in recent new coverage, ranging from extending postpartum coverage from 60 days to one year to new dental coverage for adults.

Source link

About Alex S. Crone

Check Also

Calls for fillers to be prescription only to stop the “conveyor belt” of procedures

DERMAL fillers are a popular choice for cosmetic procedures in the UK. But groups have …