TennCare has made updates to Obesity and Oncology drug management. GLP-1 prior authorizations will remain active for one year with no changes to the criteria for approval as of December 1, 2025. Initial claims for oncology products will no longer be for 14-days’ supply, but instead subject to plan limitations, quantity limits and prior authorization criteria taking effect January 1, 2026. For comprehensive, clinical criteria, please visit the TennCare/Optum Rx® website and scroll to find “PDL Criteria” under “Useful Links”.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.