Pharmacy
As of August 1, 2005 a five (5) prescription limit per month on prescription drugs and refills went into effect for many TennCare Enrollees. To find out more about the related changes, the following information is provided to both enrollees and providers:
- Prescription Limitations and Benefit Change Summary (pdf, 20kb)
- Prescription Questions and Answers (pdf, 63kb)
Enrollees Not Affected
The following TennCare enrollees are not affected by the script limits:
- Children under age 21
- Enrollees who are receiving nursing home care or other long term care that TennCare pays for (as long as they are TennCare eligible).
Effective February 1, 2006, the TennCare Pharmacy Program will revise 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.
Enrollees are encouraged to work with their providers to adapt to the Automatic Exemption List. Providers are encouraged to help their patients identify needed medications and assist them in making the best possible choices regarding the options available.
Can't get your medicine (pdf, 193kb) until TennCare OKs it?
