As a healthcare provider in the state of Tennessee, I have no greater priority than ensuring that I can provide this state’s patients with high quality health care, especially during a national public health emergency. I am writing to express my concern regarding BlueCross BlueShield of Tennessee’s (BCBST) specialty pharmacy pilot program scheduled to take effect July 1, 2020. This new mandate would leave my hands tied when it comes to choosing the most effective and efficient model in which to obtain my patients’ necessary medications. I implore you to give these concerns due consideration before implementing this new program With this mandate in place, my office will be unable to acquire the patients’ medications in a manner that keeps my practice financially solvent. Therefore, I fear I will not be able to continue treating your patients. As someone who has pursued years of schooling and training to devote myself to this profession of patient dedication, I feel a duty to present the facts and information when their care and disease management is threatened. Consider a chronically ill patient who must be able to receive the right medication at the right time, without interruption or delay. Specialty pharmacies greatly hinder that ability. The drug administration fees alone will not cover my overhead costs, and I will be forced to stop treating that patient. They are then pushed to seek care elsewhere, likely a costly hospital setting, which results in a long, and complicated battle for access to affordable treatment to the patient, which unfortunately may end with the patient being unable to receive treatment at all. I am certain that you understand the health implications when a patient suddenly stops their necessary treatment protocol. Any cost savings generated from mandating specialty pharmacy use will be used very quickly when patients are being treated in hospital settings for double or triple the cost of an office-based setting. If patients lose access to infusion care completely, the economic burden associated with undermanaged disease will far outweigh this savings as well. There are a number of reasons why we strongly oppose specialty pharmacy acquired drugs in addition to increased administrative overhead. There is serious additional work required for coordination of treatment timing, drug ordering, prior authorization, and inventory management. There will be increased drug waste when using specialty pharmacies for infusible drugs compared to the buy-and-bill process. These issues just add to the overall burden placed on us as providers, and we are supposed to be the ones that are there to provide for the patients. I know that my patients completely rely on me to be able to get them the right medication at the right time, in the correct dose, in the care setting that works best for them , and without a doubt, I know that I could not fulfill those needs under a specialty pharmacy acquisition model. Given the current health climate, we must be able to care for our patients in the safest way possible. We therefore urge BCBST to reconsider implementing a pharmacy program that could exacerbate the provider community’s existing financial woes and limit the availability of critical care services for the most vulnerable patients. Thank you for your timely consideration of our concerns. Sincerely,

As a healthcare provider in the state of Tennessee, I have no greater priority than ensuring that I can provide this state’s patients with high quality health care, especially during a national public health emergency. I am writing to express my concern regarding BlueCross BlueShield of Tennessee’s (BCBST) specialty pharmacy pilot program scheduled to take effect July 1, 2020. This new mandate would leave my hands tied when it comes to choosing the most effective and efficient model in which to obtain my patients’ necessary medications. I implore you to give these concerns due consideration before implementing this new program With this mandate in place, my office will be unable to acquire the patients’ medications in a manner that keeps my practice financially solvent. Therefore, I fear I will not be able to continue treating your patients. As someone who has pursued years of schooling and training to devote myself to this profession of patient dedication, I feel a duty to present the facts and information when their care and disease management is threatened. Consider a chronically ill patient who must be able to receive the right medication at the right time, without interruption or delay. Specialty pharmacies greatly hinder that ability. The drug administration fees alone will not cover my overhead costs, and I will be forced to stop treating that patient. They are then pushed to seek care elsewhere, likely a costly hospital setting, which results in a long, and complicated battle for access to affordable treatment to the patient, which unfortunately may end with the patient being unable to receive treatment at all. I am certain that you understand the health implications when a patient suddenly stops their necessary treatment protocol. Any cost savings generated from mandating specialty pharmacy use will be used very quickly when patients are being treated in hospital settings for double or triple the cost of an office-based setting. If patients lose access to infusion care completely, the economic burden associated with undermanaged disease will far outweigh this savings as well. There are a number of reasons why we strongly oppose specialty pharmacy acquired drugs in addition to increased administrative overhead. There is serious additional work required for coordination of treatment timing, drug ordering, prior authorization, and inventory management. There will be increased drug waste when using specialty pharmacies for infusible drugs compared to the buy-and-bill process. These issues just add to the overall burden placed on us as providers, and we are supposed to be the ones that are there to provide for the patients. I know that my patients completely rely on me to be able to get them the right medication at the right time, in the correct dose, in the care setting that works best for them , and without a doubt, I know that I could not fulfill those needs under a specialty pharmacy acquisition model. Given the current health climate, we must be able to care for our patients in the safest way possible. We therefore urge BCBST to reconsider implementing a pharmacy program that could exacerbate the provider community’s existing financial woes and limit the availability of critical care services for the most vulnerable patients. Thank you for your timely consideration of our concerns. Sincerely,

As a healthcare provider in the state of Tennessee, I have no greater priority than ensuring that I can provide this state’s patients with high quality health care, especially during a national public health emergency. I am writing to express my concern regarding BlueCross BlueShield of Tennessee’s (BCBST) specialty pharmacy pilot program scheduled to take effect July 1, 2020. This new mandate would leave my hands tied when it comes to choosing the most effective and efficient model in which to obtain my patients’ necessary medications. I implore you to give these concerns due consideration before implementing this new program With this mandate in place, my office will be unable to acquire the patients’ medications in a manner that keeps my practice financially solvent. Therefore, I fear I will not be able to continue treating your patients. As someone who has pursued years of schooling and training to devote myself to this profession of patient dedication, I feel a duty to present the facts and information when their care and disease management is threatened. Consider a chronically ill patient who must be able to receive the right medication at the right time, without interruption or delay. Specialty pharmacies greatly hinder that ability. The drug administration fees alone will not cover my overhead costs, and I will be forced to stop treating that patient. They are then pushed to seek care elsewhere, likely a costly hospital setting, which results in a long, and complicated battle for access to affordable treatment to the patient, which unfortunately may end with the patient being unable to receive treatment at all. I am certain that you understand the health implications when a patient suddenly stops their necessary treatment protocol. Any cost savings generated from mandating specialty pharmacy use will be used very quickly when patients are being treated in hospital settings for double or triple the cost of an office-based setting. If patients lose access to infusion care completely, the economic burden associated with undermanaged disease will far outweigh this savings as well. There are a number of reasons why we strongly oppose specialty pharmacy acquired drugs in addition to increased administrative overhead. There is serious additional work required for coordination of treatment timing, drug ordering, prior authorization, and inventory management. There will be increased drug waste when using specialty pharmacies for infusible drugs compared to the buy-and-bill process. These issues just add to the overall burden placed on us as providers, and we are supposed to be the ones that are there to provide for the patients. I know that my patients completely rely on me to be able to get them the right medication at the right time, in the correct dose, in the care setting that works best for them , and without a doubt, I know that I could not fulfill those needs under a specialty pharmacy acquisition model. Given the current health climate, we must be able to care for our patients in the safest way possible. We therefore urge BCBST to reconsider implementing a pharmacy program that could exacerbate the provider community’s existing financial woes and limit the availability of critical care services for the most vulnerable patients. Thank you for your timely consideration of our concerns. Sincerely,

As a healthcare provider in the state of Tennessee, I have no greater priority than ensuring that I can provide this state’s patients with high quality health care, especially during a national public health emergency. I am writing to express my concern regarding BlueCross BlueShield of Tennessee’s (BCBST) specialty pharmacy pilot program scheduled to take effect July 1, 2020. This new mandate would leave my hands tied when it comes to choosing the most effective and efficient model in which to obtain my patients’ necessary medications. I implore you to give these concerns due consideration before implementing this new program With this mandate in place, my office will be unable to acquire the patients’ medications in a manner that keeps my practice financially solvent. Therefore, I fear I will not be able to continue treating your patients. As someone who has pursued years of schooling and training to devote myself to this profession of patient dedication, I feel a duty to present the facts and information when their care and disease management is threatened. Consider a chronically ill patient who must be able to receive the right medication at the right time, without interruption or delay. Specialty pharmacies greatly hinder that ability. The drug administration fees alone will not cover my overhead costs, and I will be forced to stop treating that patient. They are then pushed to seek care elsewhere, likely a costly hospital setting, which results in a long, and complicated battle for access to affordable treatment to the patient, which unfortunately may end with the patient being unable to receive treatment at all. I am certain that you understand the health implications when a patient suddenly stops their necessary treatment protocol. Any cost savings generated from mandating specialty pharmacy use will be used very quickly when patients are being treated in hospital settings for double or triple the cost of an office-based setting. If patients lose access to infusion care completely, the economic burden associated with undermanaged disease will far outweigh this savings as well. There are a number of reasons why we strongly oppose specialty pharmacy acquired drugs in addition to increased administrative overhead. There is serious additional work required for coordination of treatment timing, drug ordering, prior authorization, and inventory management. There will be increased drug waste when using specialty pharmacies for infusible drugs compared to the buy-and-bill process. These issues just add to the overall burden placed on us as providers, and we are supposed to be the ones that are there to provide for the patients. I know that my patients completely rely on me to be able to get them the right medication at the right time, in the correct dose, in the care setting that works best for them , and without a doubt, I know that I could not fulfill those needs under a specialty pharmacy acquisition model. Given the current health climate, we must be able to care for our patients in the safest way possible. We therefore urge BCBST to reconsider implementing a pharmacy program that could exacerbate the provider community’s existing financial woes and limit the availability of critical care services for the most vulnerable patients. Thank you for your timely consideration of our concerns. Sincerely,

As a healthcare provider in the state of Tennessee, I have no greater priority than ensuring that I can provide this state’s patients with high quality health care, especially during a national public health emergency. I am writing to express my concern regarding BlueCross BlueShield of Tennessee’s (BCBST) specialty pharmacy pilot program scheduled to take effect July 1, 2020. This new mandate would leave my hands tied when it comes to choosing the most effective and efficient model in which to obtain my patients’ necessary medications. I implore you to give these concerns due consideration before implementing this new program With this mandate in place, my office will be unable to acquire the patients’ medications in a manner that keeps my practice financially solvent. Therefore, I fear I will not be able to continue treating your patients. As someone who has pursued years of schooling and training to devote myself to this profession of patient dedication, I feel a duty to present the facts and information when their care and disease management is threatened. Consider a chronically ill patient who must be able to receive the right medication at the right time, without interruption or delay. Specialty pharmacies greatly hinder that ability. The drug administration fees alone will not cover my overhead costs, and I will be forced to stop treating that patient. They are then pushed to seek care elsewhere, likely a costly hospital setting, which results in a long, and complicated battle for access to affordable treatment to the patient, which unfortunately may end with the patient being unable to receive treatment at all. I am certain that you understand the health implications when a patient suddenly stops their necessary treatment protocol. Any cost savings generated from mandating specialty pharmacy use will be used very quickly when patients are being treated in hospital settings for double or triple the cost of an office-based setting. If patients lose access to infusion care completely, the economic burden associated with undermanaged disease will far outweigh this savings as well. There are a number of reasons why we strongly oppose specialty pharmacy acquired drugs in addition to increased administrative overhead. There is serious additional work required for coordination of treatment timing, drug ordering, prior authorization, and inventory management. There will be increased drug waste when using specialty pharmacies for infusible drugs compared to the buy-and-bill process. These issues just add to the overall burden placed on us as providers, and we are supposed to be the ones that are there to provide for the patients. I know that my patients completely rely on me to be able to get them the right medication at the right time, in the correct dose, in the care setting that works best for them , and without a doubt, I know that I could not fulfill those needs under a specialty pharmacy acquisition model. Given the current health climate, we must be able to care for our patients in the safest way possible. We therefore urge BCBST to reconsider implementing a pharmacy program that could exacerbate the provider community’s existing financial woes and limit the availability of critical care services for the most vulnerable patients. Thank you for your timely consideration of our concerns. Sincerely,