Welcome to TennCare

Welcome to the Optum Rx and TennCare website, where you can find information to meet your pharmacy needs.

NEW TennCare Pharmacy Updates Newsletter click here to subscribe.

May 20, 2024: Please check back for updates regarding TennCare’s diaper benefits launching this summer. 

Please note time change: The July 30th, 2024, Drug Utilization Committee (DUR) Board meeting will be held onsite from 9:30am-12pm at the Tennessee Library and Archives (TSLA), 1001 Rep. John Lewis Way N, West Tennessee Room, Nashville, TN 37219

Please visit www.tn.gov/tenncare/diapers for information on the TennCare and CoverKids diaper benefit.

TennCare 2023 Cost of Dispensing Survey Results

Link to 9/28/23 webinar recording 
Passcode: ujXQ*$95

TennCare-Cost of Dispensing Survey Final Report Summary

TennCare-Cost of Dispensing Survey Final Report Summary

 

Provider Login

Providers can login to CoverMyMeds to access features like Web PA for prescribers and Web RA for pharmacies.

Covermymeds.com

 

Useful Links

Report Fraud and Abuse     
Report Provider Fraud >

Preferred Drug List     
TennCare PDL >      
Criterial PDL >      
Interim Criteria for Agents Awaiting PAC Review > 
 

*Please use Google Chrome, Microsoft Edge, or Firefox as your browser to access the files on the TennCare site. Other browsers like Internet Explorer cause issues with functionality and links between files.

Prior Authorization for Prescribers 
Learn more > 

Prescriber

As the main caregiver of our member’s health, OptumRx is excited to partner with you on educating and providing care for our members. Here you will find important Program Information, Prior Authorization Forms, Clinical Criteria and all Prescriber Communications needed to provide an overall continuity of care.

NEW TennCare Pharmacy Updates Newsletter click here to subscribe.

Please use Google Chrome, Microsoft Edge, or Firefox as your browser to access the files on the TennCare site. Other browsers like Internet Explorer cause issues with functionality and links between files.

2023 BESMART Virtual Education

Prescriber Communications

Prior Authorization Forms

Program Information

RetroDUR Initiatives

Clinical Criteria and Preferred Drug List

Related Links:

TennCare >

CoverRx >

CoverKids >

Pharmacist

OptumRx looks forward to partnering with our Pharmacists in providing quality pharmacy services to our members. Here you will find how to enroll and become a TennCare Pharmacist, Program Information, Clinical Criteria, Patient Forms and all Pharmacy Communications.

May 20, 2024: Please check back for updates regarding TennCare’s diaper benefits launching this summer.

NEW TennCare Pharmacy Updates Newsletter click here to subscribe.

Please visit www.tn.gov/tenncare/diapers for information on the TennCare and CoverKids diaper benefit.

Please use Google Chrome, Microsoft Edge, or Firefox as your browser to access the files on the TennCare site. Other browsers like Internet Explorer cause issues with functionality and links between files.

Program Information

Pharmacy Communications

Enrollee Forms

Clinical Criteria and Preferred Drug List

Provider Manual

Related Links:

TennCare >

CoverRx >

CoverKids >

Mercer Dispense Fee Survey and Webinars >

TennCare 2023 Cost of Dispensing Survey Results

Link to 9/28/23 webinar recording

Passcode: ujXQ*$95

TennCare Cost of Dispensing Survey Results >

Mercer AAAC Pricing >

TennCare AAAC Survey Presentation >

CoverRx/CoverKids MAC List > 

Enrollee

As a member of TennCare, OptumRx is here to help with your pharmacy needs. Here you can find participating pharmacy, order a replacement ID card and much more.

We obey federal and state civil rights laws. We do not treat people in a different way because of their race, color, national origin, language, age, disability, religion, or sex. Do you think we did not help you or you were treated differently because of your race, color, national origin, language, age, disability, religion, or sex? To report different treatment to TennCare find more information at: https://www.tn.gov/tenncare/members-applicants/civil-rights-compliance.html or email: HCFA.fairtreatment@tn.gov.

Enrollee Forms

Enrollee Tools


Related Links:

TennCare

CoverRx

CoverKids

Drug Utilization Review (DUR) Board Committee

OptumRx is excited to participate and facilitate the Drug Utilization Review (DUR) Board meetings. On this page find DUR Board members, as well as Agendas, Presentations and Minutes from previous meetings

DUR Board Members

DUR Agendas

DUR Schedules

DUR Minutes

DUR Presentations


Related Links:

TennCare

CoverRx

CoverKids

Pharmacy Advisory Committee (PAC)

OptumRx is excited to participate and facilitate the Pharmacy Advisory Committee (PAC) meetings. On this page find PAC Members as well Agendas, Presentations and Minutes from previous meetings.

TennCare Industry Day Presentations    
Please click here to learn more and register for a time slot.

Contact Us

The next Pharmacy Advisory Committee (PAC) meeting is scheduled for Thursday, August 8, 2024, 9:30 am CST – 3:30 pm CST and will be VIRTUAL ONLY.

Meeting Phone Number and Conference ID: 1 952-222-7450, 839 418 665#  

To access the meeting: Microsoft Teams Meeting: Click here to join the meeting

PAC Board Members

PAC Agendas

PAC Schedules

PAC Minutes

Review Packets

Drug class quarterly review schedules

Related Links:

TennCare

CoverRx

CoverKids

PAC Requests for Public Testimony

TennCare Industry Day Information