BCBS of Tennessee specialty drug change brings physician backlash

Physicians are speaking out against a new specialty drug policy that will affect some providers in BlueCross BlueShield of Tennessee's network come Jan. 1.

Under the new policy, BCBS of Tennessee will no longer reimburse providers for some specialty drugs usually administered in a hospital or physician office setting, according to the Chattanooga Times Free Press. Specialty drugs, which have a much higher price tag, include those used to treat autoimmune disorders, cancer and other conditions.  

Under current processes, providers who administer the specialty drugs during in-home infusions or in an office or hospital setting buy the drugs from a wholesaler. Providers then bill BCBS of Tennessee for the cost of the drug plus a mark-up for infusion nurses, storage and equipment, according to the Times Free Press

The new policy will require providers to get the drugs through a specialty pharmacy in BCBS' preferred network. A BCBS spokesperson told the Times Free Press the policy aims to slow the growing cost of specialty drugs. The pharmaceuticals reflect only 1 percent of prescriptions, but nearly half of the insurer's drug costs, according to the publication. 

"We're not asking providers to change their current process other than having [the drugs] shipped from a different source than they are today. We're still going to pay providers for administering the drugs and for those visits by members," a BCBS of Tennessee spokesperson told the publication.

The new method will require the drugs to be shipped from a preferred pharmacy to the ordering physician, a process that will likely take 24 hours. Providers affected by the change say it may cause them to end infusion services and disrupt patient care if patients have to find a new place to receive the drugs. While intended to lower costs, Joseph Huffstutter, MD, chairman of the Tennessee Medical Association's legislative committee, said the policy will do the opposite.

"I feel like my patients and fellow physicians are being experimented on in order to optimize profits," Dr. Huffstutter told the publication.

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