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Pharmacy

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 TennCare Pharmacy Program at: 1-888-816-1680.

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 February 1, 2006, the TennCare Pharmacy Program revised the prescription limit program to allow 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.

Additional Program Information and Documents such as the Pharmacy ManualAuto Exempt ListPreferred Drug List  and Prior Authorization Forms can be found at OptumRx.com/TennCare .