Draft Medical Policies
BlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee works to ensure that Medical Policies are developed in an open, collaborative manner with our providers. We invite you to submit comments during the development phase of our Medical Policies.

Medical policies are developed using an evidence-based evaluation process. The medical evidence used in this process comes from several sources, including independent medical technology review organizations, the peer reviewed medical literature, and expert opinions from BCBST network specialists. We especially welcome comments that include this type of information. All Medical Policies are reviewed and approved by a panel of BCBST Medical Directors as well as board certified network physicians before final adoption by the company.

Tracking Number

Medical Policy Name

Beginning of Comment Period

End of Comment Period


Ablation Treatments for Barrett’s Esophagus

11/09/17 12/09/17


11/10/17 12/10/17
DMP1117-05 Axicabtagene Ciloleucel 11/13/17 12/13/17

Goserelin Acetate Implant

11/21/17 12/21/17

Cryosurgical Ablation of Miscellaneous Solid Tumors (e.g., Liver, Lung, Pancreas and Breast) other than Renal and Prostate

11/29/17 12/29/17
DMP1217-01 Zoster Vaccine Recombinant Adjuvanted 12/8/17 01/08/18
DMP1217-02 Vestronidase alfa-vjbk 12/08/17 01/08/18
DMP1217-03 Triptorelin extended-release injectable suspension 12/08/17 01/08/18
DMP1217-04 Benralizumab 12/08/17 01/08/18


Medical Policy Comments:

Please reference the policy name or tracking number in your comments.
To submit comments about the draft Medical Policies:
Click the “Medical Policy Comments” above or click here: Comments or Feedback.

Comments can also be mailed to:

BlueCross BlueShield of Tennessee
Medical Policy
1 Cameron Hill Circle
Chattanooga, TN 37402