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

DMP0918-14 Genetic Testing (CFTR mutations) for Cystic Fibrosis 09/21/18 10/21/18
DMP0918-15 Lanreotide 09/25/18 10/25/18
DMP0918-16 Pasireotide 09/26/18 10/26/18
DMP0918-17 Bortezomib 09/26/18 10/26/18
DMP0918-18 Bortezomib (Velcade®) 09/26/18 10/26/18
DMP0918-19 Paclitaxel (Protein-Bound) 09/26/18 10/26/18
DMP0918-20 Testosterone Pellets for Subcutaneous Implantation 09/26/18 09/26/18
DMP0918-21 Triptorelin Extended-Release Injectable Suspension 09/27/18 10/27/18
DMP0918-22 Trastuzumab 09/27/18 10/27/18
DMP1018-01 Tocilizumab (Intravenous) 10/01/18 11/01/18
DMP1018-02 Bevacizumab for the Treatment of Neoplastic Disease 10/04/18 11/04/18
DMP1018-04 Pembrolizumab 10/08/18 11/08/18
DMP1018-05 Patisiran 10/08/18 11/08/18
DMP1018-06 Mogamulizumab-kpkc 10/08/18 11/08/18
DMP1018-07 Human Papillomavirus (HPV) Vaccine 10/09/18 11/09/18
DMP1018-08 Moxetumomab pasudotox-tdfk
DMP1018-09 Lanadelumab-flyo 10/09/18 11/09/18
DMP1018-10 Intravenous Immune Globulin (IVIG) Therapy 10/11/18 11/11/18
DMP1018-11 Hyaluronan Derivatives for Intra-Articular Injection 10/11/18 11/11/18
DMP1018-12 Panitumumab 10/12/18 11/12/18
DMP1018-13 Balloon Dilation of the Eustachian Tube 10/15/18 11/15/18
DMP1018-14 Omalizumab 10/16/18 11/16/18
DMP1018-15 Ipilimumab 10/16/18 11/16/18
DMP1018-16 Serum Tumor Markers for Gastrointestinal Cancer 10/16/18 11/16/18
DMP1018-17 Lymphatic Physiologic Microsurgery for Breast Cancer-Related Lymphedema 10/16/18 11/16/18
DMP1018-18 Tumor-Treatment Fields Therapy for Glioblastoma 10/16/18 11/16/18
DMP1018-19 Durvalumab 10/16/18 11/16/18
DMP1018-20 Pemetrexed 10/17/18 11/17/18
DMP1018-21 Avelumab 10/18/18 11/18/18
DMP1018-22 Belinostat 10/18/18 11/18/18
DMP1018-23 Eribulin Mesylate 10/19/18 11/19/18


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