The Division of TennCare told the joint Government Operations Committee on Oct. 15 it is amending emergency rules to allow coverage of FDA‑approved weight‑loss drugs for TennCare enrollees and to remove a five‑prescription monthly limit for adult enrollees age 21 and older.

Ashley Reid, legislative director for TennCare, said the package amends TennCare rule chapters to (1) allow coverage of FDA‑approved weight‑loss drugs when prescribed for treatment of obesity, and (2) remove the per‑month five‑prescription quantity limit for adult enrollees. “Item number 5 on your agenda is TennCare's emergency rules that amend TennCare's existing rules to allow for the coverage of FDA approved weight loss drugs for TennCare enrollees and to remove the quantity limit on number of covered generic drugs a TennCare enrollee age 21 and older can receive per month,” Reid said.

TennCare staff described clinical safeguards. Renee Williams Clark, the division’s pharmacy director, explained TennCare uses utilization‑management tools — prior authorization, quantity limits and medical‑necessity reviews — and relies on a pharmacy advisory committee of clinicians to target coverage to appropriate patients and to manage clinical risk. “We do require that the physician or provider prescribing the medication attest that they are having and engaging in those conversations and checking in on that member frequently to ensure that that holistic or whole person, approach to treatment and change in behaviors and diet and exercise are a part of that clinical treatment process,” Reid said.

Lawmakers asked about cost, program controls and evidence. Representative Renaud asked whether the division has mitigation strategies for potential budgetary impacts; Reid described utilization management and said the drugs have been studied for benefits such as cardiovascular risk reduction in some populations. Representative Hardaway and others asked about age appropriateness, long‑term safety and whether behavioral interventions or coaching are required prior to drug therapy. TennCare staff said counseling and lifestyle interventions are standard of care and are expected components of the clinical decision to start drug therapy; providers must attest that counseling is occurring as part of prior authorization criteria.

Lawmakers also asked whether the division will provide routine reports back to the General Assembly on program utilization and outcomes. TennCare staff said they continuously analyze utilization and will respond to inquiries but did not identify a statutory reporting requirement in these rules; they described agency reporting obligations generally but did not commit to a specific new legislative reporting schedule within the emergency rule discussion.

Committee action: The committee moved for a positive recommendation. The recorded Senate count on the motion showed four ayes and one no as read on the floor; the House provided a positive recommendation. The committee gave the rule a positive recommendation.

What was not decided or specified: The emergency rules add coverage and remove the five‑prescription cap but do not create a defined legislative reporting schedule for outcomes; TennCare said it will continue routine data review and respond to legislative questions.