Tennessean Examines Effect of TennCare Changes on Access to Prescription Drugs

The Tennessean on Tuesday examined prescription drug access for current beneficiaries of TennCare, Tennessee's Medicaid managed care program, after a five-drug-per-month limit took effect Aug. 1. The limit does not affect pregnant women, beneficiaries under age 21 or beneficiaries considered "medically needy." The state has made a "short list" of other drugs that will not count toward the five-prescription limit. Through a safety net program run by St. Louis-based Express Scripts, certain beneficiaries can obtain pre-determined generic drugs at no cost and insulin for a $5 copayment, as well as use a discount card to get discounted generic and brand-name drugs. Beneficiaries also are given information on obtaining discounted or no-cost drugs directly from pharmaceutical companies. The program runs through the end of the year. However, some beneficiaries with multiple health problems and numerous prescriptions are skipping some of their medications because of the limit, the Tennessean reports. "The state is saving money, but it's at the expense of the health of patients," Phil Bradley, owner of Bradley Drug, said, adding, "Five prescriptions a month takes care of a lot of people. It doesn't take care of that percentage of the population that has multiple diagnoses." Some pharmacists say such patients' medical conditions could worsen and they might end up in a hospital because they are not taking their medications (Wissner, Tennessean, 9/6). In addition, lawmakers have said they are being overwhelmed by people calling with problems getting their medications through the safety net program, the AP/Memphis Commercial Appeal reports. Lawmakers are questioning why the state is paying $11.4 million to Express Scripts when some of the company's services are offered at no cost through not-for-profit groups. Some former TennCare beneficiaries' drug requests are being delayed because of errors in the applications, Express Scripts officials have said (AP/Memphis Commercial Appeal, 9/5).