Have TennCare

On TennCare Medicaid?

To see a list of the benefits available to TennCare enrollees, click here.

The TennCare pharmacy benefit has a monthly limit for adults 21 year old and over.

A five (5) prescription limit per month on prescription drugs and refills

• Only two (2) prescriptions or refills per month can be Brand name medications
• There is a $3 co-pay for each Brand name medication (there is no charge/co-pay for generic drugs)
• The prescription limit is counted monthly, beginning on the first day of each month

Please visit http://www.tenncare.tn.gov/tenncare/mem-pharmacy.html to learn about the Automatic Exemption List of edications. The Medications on this list DO NOT count toward the 5 prescription limit.

TennCare has also created a Preferred Drug List (PDL). If a doctor prescribes a drug that is not on the PDL he/she must ask TennCare for a Prior Approval (PA) before the enrollee can get the prescription filled.  The request and authorization for a PA usually happens quickly if the doctor submits the request for a PA correctly and timely.  Pharmacists will only dispense a 3-day supply in emergency situations.  To see the Preferred Drug List, please visit the TennCare webpage at http://www.tenncare.tn.gov/tenncare/mem-pharmacy.html.

TennCare also has a Prescriber Attestation List of medications that can be approved for TennCare members currently at their monthly prescription limit. Medications on this list can be approved for patients currently at their monthly prescription limit only if the enrollee’s doctor believes that the enrollee is at a high risk for adverse health consequences and could be hospitalized, institutionalized, or die, within the next ninety (90) days without the requested drug(s).

If you need help paying for the medications that TennCare Medicaid does not cover, please click Prescription Assistance Programs.

Enrollees who are under the age of 21 or are receiving certain long term care. i.e., nursing home, developmental center (ICF-MR), or HCBS services have no prescription limits on medically necessary medications.