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

DMP0418-19

Romidepsin

04/24/18 05/24/18
DMP0418-20

Blinatumomab

04/26/18 05/26/18
DMP0418-21

Olaratumab

04/26/18 05/26/18
DMP0418-22 Temozolomide 04/27/18 05/27/18
DMP0418-23 Reduction Mammoplasty (Non-Cancerous) 04/27/18 05/27/18
DMP0418-24

Ixabepilone

04/27/18 05/27/18
DMP0518-01

Temsirolimus

05/01/18 06/01/18
DMP0518-02

Ramucirumab

05/03/18 06/03/18
DMP0518-03

Eribulin Mesylate

05/04/18 06/04/18
DMP0518-04

Trastuzumab

05/04/18 06/04/18
DMP0518-05

Fosnetupitant/Palonosetron

05/07/18 06/07/18
DMP0518-06 Diagnosis and Treatment of Facet Joint Pain 05/09/18 06/09/18
DMP0518-07

Subcutaneous Immune Globulins

05/09/18 06/09/18
DMP0518-08

Fluocinolone Acetonide Intravitreal Implant for the Treatment of Uveitis

05/10/18 06/10/18
DMP0518-09

Rhinoplasty

05/15/18 06/15/18
DMP0518-10

Sipuleucel-T

05/15/18 06/15/18
DMP0518-11 Cetuximab 05/21/18 06/21/18
DMP0518-12 Spinal Cord Stimulation for the Treatment of Pain 05/21/18 06/21/18
DMP0518-13 Panitumumab 5/22/18 06/22/18
DMP0518-14

Aqueous Shunts and Stents for Glaucoma

5/22/18 06/22/18

 


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