On January 1st, Blue Cross Blue Shield of Tennessee (BCBST) implemented formularies for their health plans (individual, small group, and large group) that remove 17+ bleeding disorders treatments from coverage. These exclusions threaten the health of potentially hundreds of Tennesseans who live with inherited blood or bleeding disorders.
Patients who have been stable on their prescribed treatment(s) for years may now be forced to use other treatment regimens — potentially with different routes of administration or mechanisms of action. And some patients – those living with certain rare bleeding disorders, and those with inhibitors – are finding that the new formularies exclude ALL available treatments for their conditions. These vulnerable individuals face the prospect of no coverage for the medically-necessary treatments they rely on to prevent or treat painful and life- and limb-threatening bleeding. BCBST has told some families that they can pay cash for their no-longer covered medications – an impossible option, given the cost of these therapies.
The Tennessee Hemophilia and Bleeding Disorders Foundation (THBDF), Hemophilia Federation of America (HFA), and the National Hemophilia Foundation (NHF) have called on BCBST to reconsider and reverse these formulary exclusions. To date, however, BCBST has refused to restore formulary coverage for the essential medications removed from its formularies.
BCBST’s formularies create gaps in coverage that endanger the health and lives of current and future Tennesseans with a range of inherited bleeding disorders. In so doing, BCBST undermines the Affordable Care Act’s promise of meaningful health insurance for all, including people who live with serious and costly health conditions. THBDF, HFA, and NHF reiterate our demand that BCBST reverse these indefensible and harmful formulary exclusions.
