Health care

NASHVILLE, JULY 8, 2019– Representative Bryan Terry (R-Murfreesboro) recently sent letters to the Centers for Medicare & Medicaid Services (CMS) on behalf of District 48 and the Tennessee House Health Committee for support of a new proposed federal rule that would help improve the financial situation of Tennessee hospitals. The rule would adjust the formula for calculating the Medicare Area Wage Index (AWI) which would improve payments to Tennessee hospitals and help stabilize the health care market.

“Because Medicare payments are predicated on the Area Wage Index and the AWI for Tennessee is low, our hospitals, especially our rural hospitals and those located in East Tennessee, are placed at a significant financial disadvantage compared to other states,” explained Terry. “While medical equipment, supplies, and medications have continued to climb, Tennessee’s AWI has not. Hopefully, CMS will fix this disparity.”

Currently, every county in the State of Tennessee falls below the area wage index. This places Tennessee at a rank that is near the bottom of the reimbursement ranks in the country and has created a financial problem for hospitals in Tennessee. The relief CMS has proposed in this rule will help keep more Tennessee hospitals from shutting down, and it will help keep healthcare access open for our citizens.

As Chairman of the Health Committee, Terry worked with the Tennessee Hospital Association, members of his committee, and other groups to address this problem. In his letters, he pointed out that the structural make-up of AWI created a cycle that has led to the downfall of Tennessee’s reimbursement rate over the last 15 years. He emphasized that the proposed rule by CMS, CMS- 1716-P, would allow a beneficial plan to resolve the wage index disparities for hospitals with a wage index value below the 25th percentile, and would check the abuses of the “rural floor” calculation seen in other states.

“Medicare often doesn’t even pay enough to cover the costs to provide a service. TennCare often pays significantly less than Medicare. This problem has to be addressed if we want to recruit doctors and services that will keep our hospitals afloat,” stated Terry. “While this rule change won’t solve every problem in health care, it is a necessary step.”

In addition to addressing the AWI, Terry has been actively working on legislation within the House Republican CARE Plan which is aimed at decreasing costs and improving consumer driven care. He has, also, been working to increase efficiency with TennCare while looking to help Tennessee take advantage of the State Relief and Empowerment Waivers offered by the Trump Administration.

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MURFREESBORO, April 30, 2018- Rep. Terry Tackles Transparency and Drug Pricing

With prescription drug prices and health care costs on the rise, Rep. Bryan Terry, MD(R-Murfreesboro) tackled the problem head on during the 110th General Assembly with various measures aimed at transparency and pro-rating copayments. As part of his agenda, President Donald Trump has focused on prescription drug prices, and Rep. Terry led Tennessee in taking several steps to help cut costs for patients.

The lack of transparency and competition in prescription drug pricing have contributed to an environment where costs of medications have skyrocketed. President Trump mentioned the problems in his State of the Union address and his Council of Economic Advisors(CEA) found that the lack of transparency is hurting the consumer. At the center of this issue is a controversial contractual measure applied by Pharmacy Benefit Managers(PBM) to prohibit pharmacists from telling patients that their medication may be cheaper if they pay cash. The “Pharmacy Gag Clause”, as it is known in the industry, has often led to patients and their employers paying a significant greater amount for their prescriptions while the PBM’s receive a cut from the overpayment known as a clawback.

“Patients and employers should be irate that this practice even existed,” explained Rep. Terry. “I co-sponsored and amended a bill(HB 2219) that removed the gag clause to ensure that patients will have the right to know that they can pay a cheaper price.”

Rep. Terry didn’t stop there, though. At the center of Governor Haslam’s TN Together opioid legislation is a concept called partial filling of prescriptions or as Dr. Terry calls it “Patient Tailored Dispensing”. Rep. Terry was the architect behind amending the TN Together Plan to ensure patients weren’t going to over pay for prescriptions.

“The original bill placed multiple hardships on patients and providers including multiple copayments and trips to the doctor just to have pain treated which, to me, was unacceptable,” described Terry. “With the support of Speaker Harwell, I worked with the Governor and his staff, as well as Senator Haile, on language that decreases the burden and costs for patients while ensuring that we, also, decrease unnecessary opioids in medical cabinets and on the street.”

On the last day of session, Terry amended his own legislation, HB 2440, to ensure patients would only pay a prorated amount of their copayments and cost sharing for their prescriptions on controlled substances. Though TN Together authorized patient tailored dispensing, it was Terry’s legislation that protected patients from the extra burden of multiple full payments.

“I’m proud to have led in this fight in standing up for patients to improve transparency and cut prescription costs, but there is still more that needs to be done,” concluded Terry. “I look forward to continuing to address these issues to improve patient care.”

Rep. Bryan Terry, MD is the Chairman of the House Health Subcommittee and, also, serves on the full Health and Civil Justice Committees. He can be reached at rep.Bryan.Terry@Capitol.TN.Gov or at 615-741-2180.

Rep. Bryan Terry Works To Improve Healthcare

Rep. Bryan Terry Tackles Transparency and Drug Pricing