Bill to eliminate TennCare coverage for oxycodone has a federal problem

Hank Hayes • Mar 6, 2018 at 7:15 PM

Legislation has been filed that would prohibit TennCare, Tennessee’s Medicaid program, from providing coverage for any drug containing oxycodone on any of its preferred drug lists.

But the bill filed by state Sen. Frank Niceley, R-Strawberry Plains, has a major headwind in its path. Niceley’s district includes the Hawkins County portion of Kingsport.

The state’s Fiscal Review Committee says the bill violates federal law and would jeopardize federal rebates to the state’s Medicaid program, resulting in a $250.3 million negative fiscal impact to the program.

TennCare spokeswoman Sarah Tanksley said of the bill: “TennCare does not have a philosophical objection, however, the bill would be in violation of federal statute and would put TennCare at risk of losing its full federal rebate.”

TennCare recipients, according to the program, must meet prior authorization criteria to be prescribed narcotics.

Tanksley also noted TennCare is spending less on pain medications.

“For CY (calendar year) 2016, the expenditures on medications for pain (opioids) was $40,652,801,” she said in an email. “For CY2017, the expenditures were $30,176,185. These numbers are from our controlled substance report, which we update annually. It is worth noting that the numbers are for all controlled substances prescribed for pain, which is almost nearly all opioids.”

Drugs for opiate detoxification are also on TennCare’s preferred drug list.

Still, in a recent meeting with members of the Times News Editorial Board, Northeast Tennessee prosecutors pointed out TennCare pays for dispensing a lot of narcotics.

The cost in terms of drug-addicted babies, said District Attorney General Tony Clark, is $50,000-$70,000 per baby.

“The copays (for opioids) are so low … maybe as low as $3,” Sullivan County District Attorney General Barry Staubus stressed.

District Attorney General Dan Armstrong said of opioids: “You can sell them for $30 a pill and get 20 pills for your own habit.”

Prosecutors said they are getting frustrated with the high fiscal notes related to drug bills in the General Assembly.

“The question is: How committed is the legislature to substantively solving the opioid problem?” Staubus asked. “I know we want to be about low taxes and we want to be careful about our spending. … The question is are you going to spend a little money to save more money in the long run? How do we put a price tag on these lives?”

Clark added: “The higher percentage of our DUIs now are drug-related, not alcohol. … The last four homicides in my district have been drug-related. … You look at everything we do, it stems from the drug epidemic … pot, pills, the opiates.”

TennCare provides health care for approximately 1.4 million Tennesseans and operates with an annual budget of approximately $11.8 billion. TennCare members are primarily low-income pregnant women, children and individuals who are elderly or have a disability. TennCare covers approximately 20 percent of the state’s population, 50 percent of the state’s births and 50 percent of the state’s children. The federal government funds about 65 percent of the program with the state paying for the remainder.

Recommended for You