Zane Seals, chief financial officer for TennCare, summarized a series of amendments, renewals and option-year exercises for vendors supporting pharmacy administration, provider enrollment data and TennCares IT modernization effort.

Seals described a requested modification to OptumRx, TennCares pharmacy benefit administrator. The agency asked for an extra three months on the final option year (a 15-month period) to shift the contract cycle from JanuaryDecember to AprilMarch. Seals said that federal pharmacy changes often take effect on Jan. 1 and TennCare prefers not to switch pharmacy administrators on the same day to avoid service disruptions to members and pharmacists.

Seals also presented renewals and option-year exercises for other vendor contracts that support TennCare operations, including the Council for Affordable Quality Healthcare (CAQH) for provider data, Equifax for verification services, Kepro for utilization management, KPMG for Medicaid modernization technical advisory services, Mercer for pharmacy price-setting work and NTT DATA for broader IT services. He said reprocurement for some large IT contracts is underway and that TennCares IT spending peaked last fiscal year and is projected to decline over the next several years.

Committee members approved the OptumRx amendment, CAQH, Equifax, Kepro and other amendments presented in the TennCare block of the agenda.

Why it matters: Pharmacy administration, provider data integrity and IT modernization affect access to care, claims payment and program integrity for Medicaid enrollees. The timing change for OptumRx aims to reduce risk of disruption to member pharmacy services.

What to watch: TennCare said it will continue reprocuring several large IT contracts and expects IT spending to decline as modernization milestones are completed.