TennCare to Launch ‘Ambitious’ Study of Pharmacy Program
TennCare, Tennessee's Medicaid managed care program, is launching an "ambitious effort" on Aug. 28 to determine "why it is spending so much" on prescription drugs, "root out waste and fraud" and improve quality of care, the Nashville Tennessean reports. Tennessee, which covers about 25% of the state's population through TennCare, has one of the nation's "highest per-capita consumption" rates for prescription drugs, Leo Sullivan, director of TennCare's pharmacy program, said. But Sullivan "denied" that the analysis is aimed at reducing TennCare prescription drug benefits. Sullivan said the analysis will examine only drugs used to treat mental health conditions and medications prescribed to those TennCare beneficiaries who are also covered by Medicare. The latter category costs the state about $60 million per month, the Tennessean reports. Applied Health Outcomes, a division of Navigant Consulting Inc., will conduct the drug analysis, which is expected to be completed next month. In addition, Prudent Rx Inc. will study "waste and abuse" in the TennCare pharmacy program. Prudent Rx has estimated that it could save the state $300,000 to $400,000 per month by "catching billing errors and outright fraud" among pharmacists. Although Sullivan said that the savings would only represent about one-half of 1% of the program's budget, he added that "once one guy is caught doing wrong, everybody will tighten up a little bit." He said that pharmaceutical companies and other "outside interests" will fund the studies (Snyder, Nashville Tennessean, 8/25). For further information on state health policy in Tennessee, visit State Health Facts Online.
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