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.

Adult enrollees are able to exceed the monthly 5 prescription or 2 brand limits for certain medications in high risk situations with any medication that is posted on the Automatic Exemption List. Effective in March of 2020, TennCare’s Prescriber Attestation List was added to the Automatic Exemption List , so medications posted on this list also do not count towards limits. It is no longer necessary for prescribers to make a request for an Attestation, as these medications automatically do not count towards limits.

Additional Program Information and Documents such as the Pharmacy Manual, Auto Exempt ListPreferred Drug List and Prior Authorization Forms can be found at .