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
DMP1019-23 Brolucizumab-dbll 10/30/19 - reposted 11/25/19 12/25/19
DMP1119-10 Pegaspargase 11/14/19 12/14/19
DMP1119-11 Romidepsin 11/18/19 12/18/19
DMP1119-12 Burosumab-twza 11/18/19 12/18/19
DMP1119-13 Temozolomide for Injection 11/19/19 - reposted 12/13/19 1/13/20
DMP1119-14 Pembrolizumab 11/21/19 12/21/19
DMP1119-15 Inotuzumab Ozogamicin 11/21/19 12/21/19
DMP1219-01 Vedolizumab 12/3/19 01/3/20
DMP1219-02 AbobotulinumtoxinA 12/4/19 - reposted 12/11 01/11/20
DMP1219-03 Luspatercept-aamt 12/9/19 01/9/20
DMP1219-04 Bortezomib (Intravenous Only) 12/13/19 1/13/20
DMP1219-05 Measurement of Serum Antibodies to Selected Biologic Agents 12/13/19 1/13/20
DMP1219-06 Palonosetron Hydrochloride 12/13/19 1/13/20
DMP1219-07 Breast Cancer Gene Expression Assays 12/13/19 1/13/20

Infliximab Biosimilar Products

12/13/19 1/13/20


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