BlueCross BlueShield of Tennessee
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Upcoming Medical Policies BlueCross BlueShield of Tennessee |
Each medical policy listed below will become effective on the date indicated, and will be included in the Medical Policy Manual for BlueCross BlueShield of Tennessee on that effective date.
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 opinions from appropriate network specialists. All Medical Policies are reviewed by a panel of internal and external physicians before being adopted by the company.
Topics due to be included in the Medical Policy Manual on 05/31/2024
Topics due to be included in the Medical Policy Manual on 07/02/2024
Topics due to be included in the Medical Policy Manual on 07/31/2024
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Topics due to be included in the Medical Policy Manual on 5/31/2024:
Asparaginase Erwinia chrysanthemi (recombinant)-rywn (Rylaze™)
Eflapegrastim-xnst (Rolvedon™)
Intravenous Immune Globulin (IVIG)
Pemetrexed (Alimta®; Pemfexy™, Pemetrexed™, Pemrydi RTU)
Rituximab Products (Non-Oncolgy Indications)
Rituximab Products (Hematologic and Oncolgy Indications)
Rituximab and Hyaluronidase Human Injection (Rituxan Hycela®)
Sacituzumab Govitecan-hziy (Trodelvy®)
Tocilizumab (Actemra®); Tocilizumab-bavi (Tofidence™)
Travoprost Intracameral Implant (iDose TR®))
Topics due to be included in the Medical Policy Manual on 7/02/2024:
Abobotulinumtoxin A (Dysport®)
Enfortumab Vedotin-ejfv (Padcev®)
Exagamglogene Autotemcel (Casgevy™)
Incobotulinumtoxin A (Xeomin®)
Mirvetuximab Soravtansine-gynx (Elahere™)
Rimabotulinumtoxin B (Myobloc®)
Topics due to be included in the Medical Policy Manual on 7/31/2024:
Step Therapy Requirements for Provider Administered Specialty Medications
Artificial Intervertebral Disc
Bevacizumab Products (Avastin®; Mvasi® ; Zirabev™; Alymsys®; Vegzelma™, Avzivi®
Bortezomib (Velcade®; Bortezomib)
Ciltacabtagene Autoleucel (Carvykti™)
Daratumumab and hyaluronidase-fihj (Darzalex Faspro®)
Idecabtagene Vicleucel (Abecma®)
Infliximab Products: Infliximab (Remicade®); Infliximab axxq (Avsola™), Infliximab dyyb (Inflectra™); Infliximab abda (Renflexis™); Infliximab-dyyb (Zymfentra), inflixima
Sirolimus protein-bound particles for injectable suspension (albumin-bound) (Fyarro™)
Zoledronic Acid (Zometa®), Zoledronic Acid
Last Review Date: 5/9/2024
Please reference the policy name in your comments.
To submit comments about the upcoming Medical policies:
Click the “Medical Policy Comments” above or click here: Comments or Feedback.Please reference the policy name in your comments.
To submit comments about the upcoming Pharmacy policies:
Click the “Pharmacy 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