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.

Policy # Policy Name Date Posted Date Removed
DMP0624-28 Inclisiran 06/26/24 07/26/24
DMP0624-29 Mirikizumab-mrkz 06/26/24 07/26/24
DMP0624-30 Risankizumab-rzaa 06/26/24 07/26/24
DMP0624-31 Secukinumab 06/26/24 07/26/24
DMP0624-32 Tildrakizumab-asmn 06/26/24 07/26/24
DMP0624-33 Vedolizumab 06/26/24 07/26/24
DMP0724-02 Abatacept 07/01/24 08/01/24
DMP0724-03 Cemiplimab-rwlc 07/01/24 08/01/24
DMP0724-04 Certolizumab Pegol 07/01/24 08/01/24
DMP0724-05 Fam-trastuzumab Deruxtecan-nxki 07/01/24 08/01/24
DMP0724-06 Golimumab 07/01/24 08/01/24
DMP0724-07 Infliximab Products 07/01/24 08/01/24
DMP0724-08 Lisocabtagene Maraleucel 07/01/24 08/01/24
DMP0724-09 Pembrolizumab 07/01/24 08/01/24
DMP0724-10 Tocilizumab (Actemra®); Tocilizumab-bavi (Tofidence™); Tocilizumab-aazg (Tyenne®) 07/01/24 08/01/24
DMP0724-11 Sotatercept-csrk 07/01/24 08/01/24
DMP0724-12 Delandistrogene moxeparvovec-rokl (Elevidys®) 07/10/24 08/10/24
DMP0724-13 Durvalumab (Imfinzi®) 07/10/24 08/10/24
DMP0724-14 Reslizumab (Cinqair®) 07/25/24 08/25/24
DMP0724-15 Risankizumab-rzaa (Skyrizi®) 07/25/24 08/25/24
DMP0724-16 Tezepelumab-ekko (Tezspire®) 07/25/24 08/25/24
DMP00724-17 Trastuzumab Products (Herceptin®, Ontruzant®, Herzuma®, Ogivri®, Trazimera™, Kanjinti™, Hercessi™) 07/25/24 08/25/24

 

Pharmacy Policy Comments:

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

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