Tennessee | Winter | 2010 | Health Plan Analysis
Tennessee Gov. Phil Bredesen likely will not have to enact draconian cuts to TennCare this year, but is still pursuing two methods to trim the pharmacy program in ways that will cut into pharmaceutical profits across the supply chain. His original pharmacy benefit cuts included narrowing the state’s list of preferred drugs, $4 pricing on widely available generic drugs, a reduction in the pharmacy payment on generic drugs and going to a single vendor source for selected pharmaceutical supplies. However, it now appears that only the narrowing of the PDL and supplies vendors are still being pursued. The move provides insight into the measures some states are willing to take as Medicaid budgets tighten. BlueCross BlueShield of Tennessee, the state’s largest insurer, began in January to require prior authorization for specialty drugs in its Medicare Advantage BlueAdvantage plans. Before that time, prior authorization was only needed on specialty drugs that cost more that $200. UnitedHealthcare's recent moves pushing mail order distribution of certain chronic care drugs is not happening in Tennessee because of measures enacted more than a decade ago.
