STATE EXTENDS PHARMACY COVERAGE FOR 97,000 TENNCARE ENROLLEES

Court Ruling Under Examination

NASHVILLE, TENN. – Approximately 97,000 TennCare enrollees who were slated to lose their pharmacy benefit this Monday, August 1, will continue to have their prescription drugs paid for by the TennCare program for at least 10 more days.

The State is delaying elimination of pharmacy benefits for 97,000 Tennesseans described as "medically needy." Officials cite rulings from U.S. District Court Judge John Nixon, issued Friday, in which the State is seeking relief from the Grier consent decree to move forward with changes in the TennCare program.

“The court's quick and thoughtful attention to our case opened the door to preserving coverage for nearly a third of the people who are slated to be removed from the program,” Finance and Administration Commissioner Dave Goetz said. “The State is delaying the elimination of pharmacy benefits for this population so we can review the rulings to ensure that the levels of relief that we are seeking have been granted.”

The change to allow for continued coverage of prescription drugs for the Medically Needy population was submitted Friday to Federal officials at the Centers for Medicare and Medicaid Services (CMS). It means that Medically Needy enrollees will stay on TennCare, with pharmacy benefits, at least for 10-days beyond August 1. Extending the pharmacy benefit requires TennCare officials to make computer system changes this weekend, a process that typically takes weeks to complete.

Changes in TennCare set for Monday include:
· Elimination of pharmacy benefits for all uninsured, uninsurable and non-Medicaid eligible adults who are also enrolled in Medicare (waiver duals)
· Five prescription-per-month limit for adults in a Medicaid category who will remain on the program. This includes two branded and three generic drugs per month (Children and those receiving long-term care services are exempt from the pharmacy limit).

“This kind of eleventh-hour change may be confusing for enrollees and pharmacists, but we've got to stay focused on preserving the pharmacy benefit for these enrollees," Goetz said. “We are asking for everyone’s help as we work through this transition.”

State officials have already begun contacting pharmacists and physicians to notify them of the change and will continue their outreach and education efforts next week. Medically Needy enrollees do not have to do anything to continue to receive prescription drug coverage as a result of this change.

TennCare is Tennessee’s expanded Medicaid program that provides health insurance to approximately 1.3 million people.