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

DMP0318-20

Infliximab-abda

03/19/18 04/19/18
DMP0318-21

Infliximab-dyyb

03/19/18 04/19/18
DMP0318-22

Bio-Engineered Skin and Soft Tissue Substitutes

03/20/18 04/20/18
DMP0318-23

Darbepoetin Alfa

03/21/18 04/21/18
DMP0318-25

Pegfilgrastim

03/22/18 04/22/18
DMP0318-26 Methoxy Polyethylene Glycol-Epoetin Beta 03/26/18 04/26/18
DMP0318-27 OnabotulinumtoxinA 03/26/18 04/26/18
DMP0318-28 RimabotulinumtoxinB 03/26/18 04/26/18
DMP0318-29 IncobotulinumtoxinA 03/26/18 04/26/18
DMP0318-30 AbobotulinumtoxinA 03/26/18 04/26/18
DMP0318-31

Tildrakizumab-asmn

03/28/18 04/28/18
DMP0418-01

Pertuzumab

04/02/18 05/02/18
DMP0418-02 Sildenafil 04/02/18 05/02/18
DMP0418-03

Voretigene Neparvovec-rzyl

04/03/18 05/03/18
DMP0418-04

Treprostinil for Continuous Subcutaneous Intravenous Infusion

04/04/18 05/04/18
DMP0418-05

Pegademase Bovine

04/05/18 05/05/18
DMP0418-06

Epoprostenol

04/06/18 05/06/18
DMP0418-07

Keratoprosthesis

04/11/18 05/11/18
DMP0418-08 Certolizumab Pegol 04/11/18 05/11/18
DMP0418-09 Tocilizumab (Intravenous) 04/11/18 05/11/18
DMP0418-10 Abatacept 04/11/18 05/11/18
DMP0418-11

Galsulfase (Intravenous)

04/12/18 05/12/18
DMP0418-12

Noninvasive Prenatal Testing Using Cell-Free Fetal DNA (cffDNA)

04/16/18 05/16/18
DMP0418-13

Laronidase

04/16/18 05/16/18
DMP0418-14

Vedolizumab

04/16/18 05/16/18
DMP0418-15 Idursulfase 04/16/18 05/16/18
DMP0418-16

Alglucosidase Alfa

04/18/18 05/18/18
DMP0418-17

Agalsidase Beta

04/18/18 05/18/18

 


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