Tennessee Pharmacists Association
TennCare

The Bureau of TennCare has disseminated a notice containing significant changes to the Preferred Drug List (PDL) of the TennCare Pharmacy Program. These changes take effect on July 1 and July 20, 2016, and are outlined below. The notice also includes quantity limit (QL) changes effective September 1, 2016. Please CLICK HERE to view the complete notice.

PREFERRED DRUG LIST (PDL) FOR TENNCARE EFFECTIVE 7-1-16

ANALGESICS

Naloxone

  • The following agent will be added to the PDL as preferred: NARCAN nasal spray PA, QL.
  • The following agent will be added to the PDL as non-preferred: Evzio PA, QL.

Changes to Prior Authorization Criteria and quantity limits for the PDL effective July 1, 2016

Effective July 1, 2016, prior authorization criteria for agents in the Short Acting Narcotics PDL class will be changed to include the following:

  • Must be prescribed by a provider with a Tennessee Medicaid Provider ID
  • Pain agreement required for all PA required agents
  • Concomitant use of benzodiazepines and opioids will only be approved under the care of, or referral to, a mental health provider
  • Prior Authorization approval duration: 3 months
  • Effective July 20, 2016: Quantity Limits: 7 day limit for all children with ACUTE pain, and for 1st fill for adults with ACUTE pain

Effective July 1, 2016, prior authorization criteria for agents in the Long Acting Narcotics PDL class will be changed to include the following:

  • Must be prescribed by a provider with a Tennessee Medicaid Provider ID
  • Pain agreement required for all PA required agents. Please refer to the Opioid and Controlled Substance Agreement document located at:https://tenncare.magellanhealth.com/static/docs/Program_Information/Patient_Med_Management_Agreement.pdf. All prior authorization fax forms will be updated to reflect this new requirement effective 7/1/16. In order to prevent a delay in processing time, please download new PA fax forms at:https://tenncare.magellanhealth.com.
  • Concomitant use of benzodiazepines and opioids will only be approved under the care of, or referral to, a mental health provider
  • Prior Authorization approval duration: 3 months
  • Established opioid tolerance will be required before approval of opioids with REMS requirements (See chart below)
Opioids Requiring a Risk Evaluation and Mitigation Strategy (REMS)
Avinza (morphine sulfate ER capsules) Kadian (morphine sulfate ER capsules)
Butrans (buprenorphine transdermal system) MS Contin (morphine sulfate CR tablets)
Dolophine (methadone hydrochloride tablets) Nucynta ER (tapentadol ER tablets)
Duragesic (fentanyl transdermal system) Opana ER (oxymorphone HCL ER tablets)
Embeda (morphine sulfate/naltrexone ER capsules) OxyContin (oxycodone HCL CR tablets)
Exalgo (hydromorphone hydrochloride ER tablets) Kadian (morphine sulfate ER capsules)

Effective July 1, 2016, all agents requiring prior authorization must be prescribed by a provider with a Tennessee Medicaid Provider ID. Providers may register at:http://tennessee.gov/tenncare/topic/provider-registration. All prior authorization fax forms will be updated to reflect this new requirement effective 7/1/16. In order to prevent a delay in processing time, please download new PA fax forms at:https://tenncare.magellanhealth.com.