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Editorial: TennCare dooms bill with fiscal analysis

Editorial: TennCare dooms bill with fiscal analysis

Posted: Thursday, July 15, 2010 9:11 am
By: By Donnetta Hawkins

WCP 7.16.10 Due to an erroneous fiscal note from the Bureau of TennCare, the Tennessee General Assembly missed a prime opportunity this year to pass legislation that would have improved the lives of thousands of Tennesseans with very little effort.
The Tennessee Medication Therapy and Monitoring Act of 2010 would have opened additional doors of communication between doctors and pharmacists – communication that is extremely important to people like me.
There are roughly 2,100 Tennesseans waiting for the lifesaving gift of an organ or tissue transplant. Sixteen years ago, I too was waiting; but thanks to the generosity of my donor and her family, I received a new liver and continue to live a healthy and active life. Not everyone on the current waiting list will be so lucky, and those who do receive a transplant will continue to face challenges, some of which center on their medications.
For transplant patients, communication between one’s doctor and pharmacist is very important. As it stands now, if your pharmacist makes a change to the medication your doctor prescribed, the pharmacist does not have to notify your doctor of that change. This is not a big deal if you are taking a prescription vitamin or a heartburn remedy. But if you are a transplant patient taking as many as 12 medications a day, you need your doctor to know if the prescription he ordered gets changed. Why? The slightest variation in anti-rejection drugs – also called immunosuppressants – can be a matter of life or death. The doctor needs information about the change so that he can properly monitor the patient for signs of organ rejection.
The Tennessee Medication Therapy and Monitoring Act, which has been before the General Assembly for two years, was never about requiring the switching of medications from a brand to a generic or vice versa. The language in the bill did not prohibit substitutions. Rather, the bill has always been about enhancing communication between the doctor and the pharmacist via e-mail, phone or fax. That is what makes the path the bill took this year even more frustrating.
Imagine my surprise when, despite the clear bill language, the Bureau of TennCare incorrectly assumed patients would be switched from generics to brand-name drugs. The resulting cost estimate – based on a wrong assumption – doomed passage of the legislation this year.
Sen. Diane Black and Rep. Debra Maggart, the bill’s sponsors, worked tirelessly on behalf of transplant patients, and for that, I offer my heartfelt thanks. I also want to thank Rep. David Shepard, a pharmacist by trade, for helping the sponsors understand how the bill could be improved. Rep. Shepard offered firsthand knowledge about how pharmacists and physicians could work together to protect the integrity of patient care.
I am hopeful that the Tennessee Medication Therapy and Monitoring Act will be brought up again next year. I am also hopeful that the Bureau of TennCare will step aside and let the legislation become law.
Donnetta Hawkins is an assistant professor of social work at Lipscomb University.


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