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 Posted
Policy Removed
DMP0219-24 Burosumab-twza 02/21/19 03/21/19
DMP0219-25 Intraoperative Radiation Therapy (IORT) 02/27/19 03/27/19
DMP0319-01 Prostatic Urethral Lift 03/01/19 04/01/19
DMP0319-02 Romidepsin 03/05/19 04/05/19
DMP0319-03 Bendamustine HCl (Bendeka®) 03/07/19 04/07/19
DMP0319-04 Bendamustine HCl (Treanda®) 03/07/19 04/07/19
DMP0319-05 Bortezomib 03/07/19 04/07/19
DMP0319-06 Bortezomib (Velcade) 03/07/19 04/07/19
DMP0319-07 Brentuximab Vedotin 03/07/19 04/07/19
DMP0319-08 Obinutuzumab 03/07/19 04/07/19
DM0319-09 Paclitaxel (Protein-Bound) 03/07/19 04/07/19
DMP0319-10 Pertuzumab 03/07/19 04/07/19
DMP0319-11 Human Amniotic Membrane Grafts and Amniotic Fluid Injections 03/08/19 04/08/19
DMP0319-12 Pembrolizumab 03/11/19 04/11/19
DMP0319-13 Belinostat 03/12/19 04/12/19
DMP0319-14 Ibalizumab-uiyk 03/13/19 04/13/19
DMP0319-15 Mepolizumab 03/13/19 04/13/19
DMP0319-16 Cetuximab 03/14/19 04/14/19
DMP0319-17 Panitumumab 03/15/19 04/15/19
DMP0319-18 Ramucirumab 03/15/19 04/15/19
DMP0319-19 Bevacizumab for the Treatment of Neoplastic Disease 03/19/19 04/19/19


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