TennCare Medicaid
Favorable for Coverage: Pharmacy Benefit (OTC)
Gelmix and Purathick are favorable for coverage as over-the-counter (OTC) products with a prescription under the pharmacy benefit.
Requirements
-Prescription required
-Prior Authorization Required
Product NDC Codes in TN
-Gelmix Infant Thickener (125g Jar): 55764-0007-02
-Gelmix Infant Thickener (2.4g Sticks): 55764-0007-11
-Purathick Natural Thickener (125g Jar): 55764-0007-03
-Purathick Natural Thickener (2.4g Sticks): 55764-0007-09
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