Updates to TennCare’s Diaper Benefit

February 28, 2025

Overview of TennCare Diaper Benefit

  • TennCare or CoverKids members under age 2 can receive 100 diapers per month from the Covered Diaper UPC list OR an alternative brand selected by the pharmacy.
  • Members obtain the diapers from the pharmacy counter at participating pharmacy locations. A list of participating pharmacies is available at Diaper Benefit Page.
  • Any pharmacy that is a part of the TennCare Pharmacy Network is eligible to participate.

Important Updates

  • On February 15, 2025, TennCare enhanced the reimbursement of covered diaper brands for pharmacies. TennCare now reimburses covered UPCs based on the brand and size of the product dispensed.
  • Effective February 28, 2025, TennCare will allow pharmacies to submit claims for diapers not on the Covered UPC list utilizing a Generic Diaper UPC. The reimbursement is based on the size of the product dispensed.
  • Since the program launched on August 7, 2024, the number of participating pharmacies has grown to 403, covering 90 counties. A new Participating Pharmacy Interactive Map is available on the Diaper Benefit Page.
  • TennCare and OptumRx have updated a change in tax reimbursement for Davidson County to reflect the increased transit tax rate as of February 1, 2025.
  • Additional details about the new reimbursement and Generic Diaper UPC can be found at the Diaper Benefit Page for Pharmacists.

Process for Diaper Manufacturers to Participate in the Program

TennCare will review and consider new diaper brands to be included on the Covered UPC list. However, it is at the pharmacy’s discretion to determine which diaper brands and sizes they choose to stock in their store for the TennCare Diaper Benefit. Please note, as of 2/28/25, pharmacists may choose to carry a diaper brand not on the Covered UPC list and can submit claims for that brand using the Generic Diaper UPC.

Any diaper manufacturer who is interested in inclusion on the Diaper UPC list must first submit product information for inclusion in Wolters Kluwer clinical drug information content, which includes the Medi-Span application utilized by TennCare Pharmacy Benefit Manager, OptumRx. Instructions and resources for submissions can be fou nd on the Wolters Kluwer Manufacturers Data Exchange website: Wolters Kluwer Manufacturers Data Exchange.

Once a manufacturer’s products have been successfully added to the database, OptumRx and TennCare will then assess the product’s Maximum Allowable Cost (MAC) and determine what UPCs will be included on the Diaper UPC list. An evaluation and review of new diaper brands and UPCs will occur on a quarterly basis.

The manufacturer is responsible for working with the Wolters Kluwer Drug Data Solutions team for system database loads and with wholesalers/distributors to ensure pharmacies can acquire the product.

If there are additional questions about the process described above, please reach out to TNRxEducation@optum.com.