Posted on 08/04/2005 4:18:34 PM PDT by SmithL
CHATTANOOGA — A federal court order expanding the state's power to restrict TennCare pharmacy benefits likely means all 97,000 medically needy enrollees can stay on the health care program, Gov. Phil Bredesen said Thursday.
"It looks positive to being able to keep all the most medically needy people on the rolls," the governor said during a stop here to promote his prekindergarten program.
Bredesen said he expected to decide the fate of the medically needy, among the sickest patients with high medical bill, early next week after administration officials finish evaluating a ruling clarification issued Wednesday by U.S. District Court Judge John Nixon in Nashville.
Two previous orders by the judge gave the state power to define what treatments are medically necessary and authorized state officials to require prior authorization for prescription drugs and the ability to limit prescriptions to five per month.
The order Wednesday imposes additional limitations on emergency supplies of medications and no longer requires the state to pay for services while an enrollee appeals a denial of coverage.
Drug benefits for the medically needy had been extended until Aug. 10. They had been due to expire Monday, when roughly 200,000 adults lost prescription drug coverage.
I guess TN will need that income tax after all, then.
Bredesen wants that income tax, that's a certainty. However, this particular ruling allows the State to provide fewer services to each client, allowing them to provide services to more clients for the same amount of money.
Well, that's a step in the right direction, at least, as long as they stand fast on their denials of services. The free med supply while awaiting approval/denial was so much crap. Limiting the RXs to five per month is a good step too, but watch how they work their way around it - they'll figure something out - someone is always trying to game the RX programs. And it damn well better eliminate the faux services - the rental car so a junkie can drive to his treatment.
It will be a cold day in Hell before we get an income tax.
That's the spirit.
Don't make me drive back there to honk my horn!
Step One: Bait
Step Two: Switch
What a joke. All the "press" reports today in the local papers was "97,000 of the most needy might not be cut from the TennCare rolls".
Oh please. TennCare could got quadruple that from among the dead, the rich, those that CAN get insurance but don't, illegal aliens, duplication (most so-called "homeless" bums have 3-5 cards), people that aren't Tenn residents, etc.
The gullable idiots among our citizens have been falling for this sham for decades. I'm sick of paying for it and will vote against any political hack, regardless of party, that thinks it's vital.
Or the cab rides the the emergency room for a headache. I saw on Tenncare bum come in and get immediate treatment for a cold. The doctor gave him Tylenol. These worthless money grubbing a-holes won't even pay for that themselves.
And they should be forced to pay a co-pay of $10-20 to go to the ER unless maybe it's a true emergency and not to get Tylenol. Oh, but you mention that and some do-gooding, bleading heart left wing fool with whine about how the "poor" can't afford that. I usually snap back, "let them sell the cellphone you f'ing jerk".
Screw the horns this time. I'm bringing my shotgun! lol And I'll DEMAND I be allowed to protest in the governor's office!
You are confusing the issue. The program is designed to help your friends father and I have no problem with that form of compassion.
I have a problem with universal, government mis-runned programs that award cronies with fat jobs and contracts, allow non-citizens, non-residents, dead people, those that can afford insurance and those that can get it work but won't to be on the program.
Government by definition is inefficient and bureaucratic and the costs balloon out of control with unauditable spending used by hack politicians to buy votes.
THAT'S what has to stop. When they start talking about dropping your freind's father from the rolls it's nothing but a SCARE tactic and a threat so idiots will shut up and enjoy an income tax being shoved down their throat (for the children) or up our butts.
I say immediately terminate the program (the courts be damned - let them try to enforce their rulings) and start over with some REAL rules, guidelines and qualifications to get on like his father.
I work in the pharmacy benefits industry. One of the plans we handle is a state benefits plan - like Tenncare - welfare folks, can't afford regular insurance, etc. I was handling an issue for a patient - we had her order for her various medications, and couldn't ship it until we received some form of payment, a credit card or a check number. I called the number we had listed for her home phone, and got her daughter on the phone. I explained who I was, asked if her mother was there - mom wasn't there. Asked her "when do you expect her home, I'm calling from the Pharmacy Benefits Company and we need payment for her medication. Daughter wasn't sure when she'd be home. I told her that we were going to have to cancel the order then, unless mom called us in 24 hours and asked if she could call on her cell phone, kid tells me "I don't think she gets cell phone coverage in Hawaii." She's on a three week vacation in Hawaii...and she's on state benefits. I'm working for the pharmacy benefits company, and I can't afford to go to Hawaii...I ask if she knows what hotel her mother is staying in - it's the Hilton. "Well, I'm pretty sure the Hilton has telephones - you need to call your mom and let her know that if she doesn't call back in 24 hours, we're going to cancel her order." We were filling scripts for her oral contraceptives, her oxycontin, hydrocodones, oxycodones. Birth control and pain meds, and she's on vacation in Hawaii. Oh, but these people need these plans, and our money.
Majority of the meds we're filling for the state welfare plans are oral contraceptives, and a potluck of pain meds. Had one today call and complain because we denied her oxycontins - she had them filled 3 days ago for a 30 day supply of 90 - and somehow, she lost them. Went and looked at the history - she would fill an oxy script, then lose it 3-4 days later, and get another one filled, wait a month, get a regular refill, and 3-4 days later, lose the medication. I took great pleasure in saying, "Ma'am, your benefits plan has asked us to have you contact them the next time you lose an oxycontin script. If you'll hold on for a moment, I'll connect you to them." She disconnected while I was calling the plan - but I still got to tell them what was going on - and watched in my system as they locked her out of benefits until she called in.
Sorry for the rambling rant -
A lot of these folks are selling the oxycontins. Not a rant, great info.
It's freaking ridiculous.
Are you sure we want this guy as Presdient???
Great stuff, Bob. I'd be happy to read your real-life stuff anytime!
If I remember right, wasn't Tenn Care offered to all State employees???????
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.