Lawsuit: New TennCare rates endanger hemophilia patients
By JONATHAN MATTISE
Jul. 18, 2017
NASHVILLE, Tenn. (AP) — Pharmacies in Tennessee are accusing the state of breaking federal law and endangering people with bleeding disorders such as hemophilia by reducing reimbursements for prescription blood-clotting drugs through its Medicaid program.
Hemophilia is very rare, affecting about 20,000 people in the United States, according to the federal Centers for Disease Control and Prevention, and the drugs used to treat it are among the most expensive on the market, according to the Hemophilia Federation of America.
A lawsuit filed last week by specialty pharmacies and their wholesaler accuses TennCare of targeting clotting-factor pharmacies, based on a faulty survey, to save $12 million to $15 million annually.
"TennCare's voluntary decision to save money by singling out clotting factor has placed the bleeding disorder community in great danger," the lawsuit says.
TennCare spokeswoman Sarah Tanksley declined to comment, citing the pending litigation.
If the reimbursement rates that took effect April 1 aren't immediately blocked, at least seven specialty pharmacies that aid about half of TennCare's bleeding disorder patients will have to withdraw from serving them and close their Tennessee operations, the lawsuit says.
Many of these patients need preventive doses several times a week, plus daily doses if they experience a bleeding event. And unlike non-specialty outpatient drugs, clotting factor has complex dispensing and medication management requirements that drive up costs, the lawsuit says.
Patients who forgo clotting treatments risk deteriorating joints and otherwise avoidable joint and bone replacement surgeries due to microscopic bleeding from normal bodily movement, the lawsuit says.
"These pharmacies cannot afford to dispense clotting factor to patients if they are losing significant amounts of money with each dispense," says the lawsuit, filed in Davidson County Chancery Court by Hemophilia Preferred Care of Memphis, Inc., First Choice Home Infusion, LLC, InTouch Pharmacy LLC and Twelvestone Medical, Inc.; and wholesaler National Cornerstone Healthcare Services, Inc.
Hemophilia Preferred Care of Memphis, Inc. said it serves 17 TennCare enrollees who need the blood-clotting drugs. Just one of them needed 530,000 units of a particular clotting drug last year; the same amount this year would mean a $160,000 loss per month for the pharmacy, the lawsuit says.