BCBS Tennessee COO Scott Pierce voiced concerns over pending state bills — accusing them of eventually “forcing higher prices” — in Feb. 26 op-ed columns published in the Leaf Chronicle and The Tennessean.
Mr. Pierce took issue with four state Senate bills — 2155, 2550, 2574 and 2576 — that he said would implicate recent efforts around pre-payment claims reviews, revised rates for select providers, specialty drug markups and lab reimbursement.
According to the insurer, one bill is currently a “caption bill,” which has developments to come. The other bills would require human oversight in AI use for coding and claims reviews, reimbursement parity across providers with varying license classifications, a 60-day notice period for material changes and reimbursement floors for pharmacy benefit managers. One would also limit PBM authority in prescribing.
“These proposed laws are unlikely to improve health outcomes or increase access,” Mr. Pierce said. “But they do ask the government to use Tennessee law to raise costs by removing important checks and balances that protect the safety and financial well-being of our members.”
Mr. Pierce also claimed the PBM bills could lead to $1.2 billion in drug costs for Tennessee families, but he did not provide details on how that figure was calculated.
In addition, Mr. Pierce addressed pending legislation focused on coverage for specific services.
“Each of the proposals are for services with real value for many Tennesseans,” he said. The problem is mandates like these can require payment for services for anyone, without evidence they’d help based on the individual’s health status. That drives up costs for everyone since each member’s premium helps pay for other people’s care, too.”
