Pharmacy Benefits Manager

OptumRx is TennCare’s pharmacy benefits manager effective January 1, 2020.

Please visit OptumRx’s TennCare Website for all information not found here.

Are you a provider who needs help with pharmacy related matters? Call the OptumRx Pharmacy Support Center at: 1-866-434-5520.

On January 16, 2018, TennCare implemented an edit on Long-Acting and Short-Acting Opioids that changes the way that TennCare pays for opioids for first-time and non-chronic opioid users. Details on this edit can be found in this document found on OptumRx’s TennCare Website.

Effective July 1, 2025, TennCare will no longer enforce the five (5) prescription limit per month on prescription drugs and refills for adult TennCare enrollees; however, the two (2) brand prescription limit per month will remain in effect.

Adult enrollees may exceed the monthly two-brand limit in certain high-risk situations for medications included on the Automatic Exemption List. In March 2020, TennCare’s Prescriber Attestation List was incorporated into the Automatic Exemption List. As a result, medications on this combined list (Automatic Exemption (Auto-Exempt) & Attestation List) automatically do not count toward monthly prescription limits. Prescribers are no longer required to submit an attestation request for these medications.

Additional Program Information and Documents such as the Pharmacy Manual, Auto Exempt & Attestation Drug List, Preferred Drug List and Prior Authorization Forms can be found at OptumRx.com/TennCare.