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Fiscal review challenges TennCare assumptions on PBM bill costing
Summary
Fiscal Review disputed TennCare's fiscal calculations for SB2040, arguing the fiscal note assumes restructuring rather than mass pharmacy closures and criticizing static assumptions about purchasing and dispensing‑fee effects.
Boyan Savic, executive director of the Fiscal Review Committee, told senators the primary difference between his office's fiscal note and TennCare's presentation is an assumption about closures and market dynamics. Fiscal Review says the fiscal note does not assume widespread closures but anticipates restructuring or divestiture and that many pharmacies could remain in operation, which would change projected reimbursement and dispensing‑fee impacts.
Savic also criticized static assumptions in the other analysis, including a continuous 16% purchasing disadvantage and failure to model market adjustments over time. He said recent PBM audits and federal probes show some offsetting changes could reduce costs if certain PBM practices are limited. ‘‘The assumption in the fiscal note is that these pharmacies have options to restructure, divest, and that they will remain in operation at least for the most part,’’ Savic said; his office concluded the net state impact ‘‘cannot be reasonably determined’’ without more dynamic modeling.
