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Participating Pharmacies

On January 16, 2018, TennCare implemented a new edit 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).

The prescription limit program allows adult enrollees to exceed the monthly 5 prescription or 2 brand limit for certain medications in high risk situations. This is in addition to over 600 hundred medications on the Automatic Exemption List that do not count towards limits. To initiate an exception request, the prescriber must call 866-434-5524. A complete listing of medications that can be considered for a prescription limit override are posted on the Prescriber Attestation List (Over the Limit) .

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.

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 TennCare Solutions Unit at 1-800-878-3192.

OptumRx’s TennCare Website