Participating Pharmacies

On January 16, 2018, TennCare implemented a new edit on Long-Acting and Short-Acting Opioids that will impact all first-time and non-chronic opioid users. Details on this edit can be found in this document found on OptumRx’s TennCare Website.

As of August 1, 2005 a five (5) prescription limit per month on prescription drugs and refills went into effect for many TennCare Enrollees.

Enrollees Not Affected

The following TennCare enrollees are not affected by the script limits:

  • Children under age 21
  • Enrollees who are receiving nursing home care or other long term care that TennCare pays for (as long as they are TennCare eligible).

Adult enrollees are able to exceed the monthly 5 prescription or 2 brand prescription limits for certain medications in high-risk situations with any medication that is posted on the Automatic Exemption (Auto-Exempt) & Attestation List. Effective in March of 2020, TennCare’s Attestation Drug List was added to the Automatic Exemption List (Auto-Exempt), so medications posted on this list also do not count towards limits.

Because the Prescriber Attestation List is now part of the Automatic Exemption List, the prescriber no longer needs to submit a request for an Attestation because medications no longer count towards limits.

Enrollees are encouraged to work with their providers to address any prescription limit issues. Providers are encouraged to help their patients identify needed medications and assist them in making the best possible choices regarding the options available. TennCare recommends that the prescribers try to prescribe TennCare Preferred medications whenever possible, found on TennCare’s Preferred Drug List.

Can't get your medicine until TennCare OKs it?

Do you need help with prescriptions or refills at the drug store? First, call your doctor. If you still need help, call the OptumRx Member Call Center at 1-888-816-1680.

OptumRx’s TennCare Website