2026 TennCare MAT Coverage Tracker: Medications, MCOs, Prior Auth, and Cost

The short answer: if you have TennCare, your medication-assisted treatment is almost certainly covered, and for most members the out-of-pocket cost is zero. The longer answer is in the tables below. They are arranged from the question patients ask first ("which medications are covered?") to the question patients ask last ("what if I need to switch insurance or pay out of pocket?"), with the mechanics of BESMART, prior authorization, telehealth, and hepatitis C in between.

One structural fact to keep in mind as you read: all three TennCare managed care organizations — BlueCare Tennessee, UnitedHealthcare Community Plan, and Wellpoint Tennessee — share one statewide pharmacy benefit manager (OptumRx) and one Preferred Drug List. The covered medications and the rules that govern them are uniform across MCOs. Differences are administrative: which member-services line you call, which portal your provider uses, which fax number receives a prior-authorization request. Restoration Recovery is BESMART-enrolled and in-network with all three at every clinic.

Table 1 — Covered MAT Medications At a Glance

The five medications below cover every FDA-approved form of MAT for opioid use disorder and the two non-buprenorphine options Restoration Recovery prescribes for alcohol use disorder. Generic buprenorphine/naloxone and acamprosate are on the OptumRx Preferred Drug List and clear without prior authorization at BESMART-enrolled clinics. The three long-acting injections (Sublocade, Brixadi, Vivitrol) and brand-name Suboxone are covered with prior authorization.

Two notes on this table. First, Restoration Recovery uses Vivitrol exclusively for alcohol use disorder. Although Vivitrol's FDA label includes opioid use disorder, the buprenorphine pathway is more clinically appropriate for OUD at our clinics. Second, acamprosate requires a patient to be abstinent from alcohol at the start of treatment. It is a maintenance medication for sobriety, not a detox aid. The TennCare Preferred Drug List places it on the lowest tier without PA precisely because it pairs with counseling rather than replacing it.

Table 2 — The Three TennCare MCOs Side by Side

The three TennCare MCOs are interchangeable from a coverage standpoint. Each has its own member-services line, provider portal, and case-management programs, but the covered drug list, BESMART rules, and prior-authorization criteria are identical. If you do not remember which MCO manages your TennCare benefits, your member ID card shows the plan name; you can also call TennCare Connect at 1-855-259-0701.

Wellpoint rebranded from Amerigroup in 2024 as part of parent company Elevance Health's consolidation of its Medicaid brands. If your card still says Amerigroup, your coverage is unchanged — the name changed but the plan, network, and benefits did not. New cards are being issued as plans renew.

Table 3 — BESMART vs. Non-BESMART Providers

What you do not need prior authorization for

Even at non-BESMART clinics, any TennCare provider can prescribe up to 16 mg/day of generic buprenorphine/naloxone as a five-day induction supply once every six months without prior authorization. This is the single most useful piece of TennCare MAT coverage to know: a patient can start treatment on day one and pick up medication at the pharmacy without waiting for insurance review. After induction, BESMART-enrolled care unlocks the unrestricted maintenance pathway.

What does require prior authorization

Prior authorization applies to: non-preferred products like brand Suboxone film or Zubsolv; doses above 24 mg/day; the buprenorphine monoproduct (without naloxone) outside of pregnancy or breastfeeding; NP or PA prescribers at non-BESMART clinics; Sublocade, Brixadi, and Vivitrol injections regardless of clinic. PA forms are submitted to OptumRx by fax via the standard Buprenorphine Products PA Form. Initial approvals run six months; reauthorization runs twelve. Reviewers look for a documented opioid use disorder diagnosis, BESMART enrollment where required, a controlled-substance monitoring database review from the past six months, and no concurrent opioid or benzodiazepine prescriptions that would conflict.

Table 4 — Telehealth Coverage Under the 2026 DEA Rules

Table 5 — Coordinated Care Covered Under BESMART

Table 6 — Hepatitis C DAA Coverage Under TennCare

TennCare covers direct-acting antiviral (DAA) therapy for hepatitis C with prior authorization. As of 2026, TennCare does not impose fibrosis-stage requirements or substance-use restrictions on DAA approval, and TennCare members co-treated for opioid use disorder and hepatitis C at the same clinic see substantially better cure rates than referral-based split care. The two pan-genotypic regimens recommended first-line by the AASLD-IDSA HCV Guidance are listed below.

Hepatitis C is increasingly common in patients with opioid use disorder, and integrated treatment is the standard of care. A 2024 randomized controlled trial in JAMA (Talal et al.) found that telemedicine-delivered, opioid-treatment-program-integrated HCV care produced 90.3 percent cure rates compared with 39.4 percent for off-site referral. For the full pillar treatment of how this works, see our integrated HCV-OUD care guide.

Typical Cost — What TennCare Members Actually Pay

For most TennCare members, MAT is covered with $0 out of pocket. TennCare does not impose member cost-sharing on medically necessary behavioral health for the majority of plan categories, generic buprenorphine/naloxone is on the lowest tier of the Preferred Drug List, and Sublocade, Brixadi, and Vivitrol are billed under the medical benefit (clinic-administered) so there is no pharmacy copay. Exact out-of-pocket cost depends on your specific plan, deductible status, and whether prior-authorization criteria are met.

If you do not have TennCare or any insurance

Restoration Recovery offers self-pay at $250 per month, which covers the medical visit and treatment management. Medication is billed separately through pharmacy or via patient-assistance programs. Self-pay is straightforward, predictable, and cheaper than the paperwork hassle of an out-of-network claim. We do not offer sliding-scale fees or payment plans — the $250 monthly rate is the structure. For the broader payment picture, see our insurance and payment overview.

Table 7 — What's Not Covered Through TennCare MAT at Restoration Recovery

Verify Your TennCare MAT Coverage Before Your First Visit

Three concrete steps turn the rules above into a same-week appointment.

1. Find which MCO manages your TennCare benefits. Your TennCare member ID card shows the plan name; if the card says "BlueCare," "UHC Community Plan," or "Wellpoint" / "Amerigroup," that is your MCO. If you do not have your card, log in at tn.gov/tenncare or call TennCare Connect at 1-855-259-0701.
2. Confirm the clinic is BESMART-enrolled with your MCO. Ask the clinic directly. Restoration Recovery is BESMART-enrolled with all three TennCare MCOs at every location. If you call us, we verify it as part of the intake conversation.
3. Schedule and bring your card. Bring your TennCare ID, a valid photo ID, a list of current medications, and any prior treatment history. Same-week appointments are typically available at all four clinic locations. Call 423-498-2000 or request a callback.

For the full prose explanation behind every line in this tracker — what BESMART actually feels like as a patient, how same-day starts work, and what to expect at the first appointment — see our pillar guide on whether TennCare covers MAT in Tennessee.

References

Primary policy, clinical, and regulatory sources cited in this tracker. Updated April 25, 2026.

1. TennCare. BESMART Program Description — Buprenorphine Enhanced Supports for Medication-Assisted Recovery Treatment. [BESMART PDF]
2. OptumRx for TennCare. Buprenorphine Products Prior Authorization Form. [OptumRx PA Form]
3. OptumRx for TennCare. TennCare Preferred Drug List (PDL). [TennCare PDL] · [OptumRx Portal]
4. State of Tennessee, Division of TennCare. Provider Administration Manual + member resources. [TennCare] · [TennCare Contact]
5. U.S. Drug Enforcement Administration and HHS. Final Rule: Expansion of Buprenorphine Treatment via Telemedicine Encounter (effective December 31, 2025). [SAMHSA]
6. Federal Register. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications (through December 31, 2026). [Federal Register]
7. American Society of Addiction Medicine. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder — 2020 Focused Update. [ASAM]
8. Substance Abuse and Mental Health Services Administration. TIP 63: Medications for Opioid Use Disorder. [SAMHSA TIP 63]
9. AASLD-IDSA. Recommendations for Testing, Managing, and Treating Hepatitis C. [HCV Guidelines]
10. Talal AH, et al. Telemedicine-Based Hepatitis C Treatment in Patients With Opioid Use Disorder: A Cluster Randomized Trial. JAMA. 2024. [JAMA 2024]
11. U.S. Code of Federal Regulations. 42 CFR Part 2 — Confidentiality of Substance Use Disorder Patient Records. [eCFR]
12. TennCare managed care organizations: BlueCare Tennessee · UnitedHealthcare Community Plan · Wellpoint Tennessee.