BlueCross BlueShield of Tennessee
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Upcoming Medical Policies BlueCross BlueShield of Tennessee |
Each medical policy listed below will become effective on the date indicated, and will be included in the Medical Policy Manual for BlueCross BlueShield of Tennessee on that effective date.
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 opinions from appropriate network specialists. All Medical Policies are reviewed by a panel of internal and external physicians before being adopted by the company.
Topics due to be included in the Medical Policy Manual on 10/31/2026
Topics due to be included in the Medical Policy Manual on 11/01/2026
Topics due to be included in the Medical Policy Manual on 12/01/2026
Topics due to be included in the Medical Policy Manual on 12/31/2026
Topics due to be included in the Medical Policy Manual on 01/01/2027
Topics due to be included in the Medical Policy Manual on 10/31/2026
Daratumumab and hyaluronidase-fihj (Darzalex Faspro®)
Intravenous Immune Globulin (IVIG)
Leuprolide Acetate (Fensolvi®)
Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Pembrolizumab and Berahyaluronidase alfa-pmph (Keytruda Qlex™)
Vestronidase Alfa-vjbk (Mepsevii®)
Etuvetidigene autotemcel (Waskyra®)
Topics due to be included in the Medical Policy Manual on 11/01/2026
Commercial & BlueCare PASD Step Therapy Requirements
Topics due to be included in the Medical Policy Manual on 12/01/2026
Alglucosidase Alfa (Lumizyme®)
Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro™)
Atidarsagene Autotemcel (LENMELDY™)
Avalglucosidase Alfa-ngpt (Nexviazyme™)
Bevacizumab Products (Avastin®; Mvasi® ; Zirabev™; Alymsys®; Vegzelma™, Avzivi®, Jobevne™)
Histrelin Acetate (Supprelin® LA)
Leuprolide acetate (Eligard®, Vabrinty™)
Leuprolide Acetate (Fensolvi®)
Leuprolide Suspension (Lupron Depot®, Leuprolide Acetate Depot 1-Month 3.75mg, 3-Month 11.25 mg)
Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®)
Leuprolide Mesylate (Camcevi ETM™; Camcevi Kit)
Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Omalizumab Products: Omalizumab (Xolair®); Omalizumab-igec (Omlyclo®)
Pegunigalsidase Alfa-iwxj (Elfabrio®)
Telisotuzumab vedotin-tllv (Emrelis™)
Testosterone Product: (Testosterone Pellets [Testopel®])
Triptorelin Pamoate (Trelstar®)
Topics due to be included in the Medical Policy Manual on 12/31/2026
Aflibercept Products (Eylea®; Eylea®HD, Ahzantive™ [aflibercept-mrbb], Enzeevu™ [Aflibercept-abzv], Eydenzelt® [Aflibercept-boav], Opuviz™ [Aflibercept-yszy], Pavblu™ [Aflibercept-ayyh], and Yesafili™ [Aflibercept-jbvf])
Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza™)
Breast Cancer Gene Expression Assays
Brentuximab Vedotin (Adcetris®)
Efgartigimod Alfa-fcab (Vyvgart®); Efgartigimod Alfa-fcab and Hyaluronidase-qvfc (Vyvgart®Hytrulo)
Exagamglogene Autotemcel (Casgevy™)
Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies
Isatuximab-irfc (Sarclisa®; Sarclisa EscenaTM)
Multiple Sclerosis Products:(Ocrelizumab [Ocrevus™], Ocrelizumab and Hyaluronidase-ocsq [Ocrevus Zunovo™], Ublituximab-xiiy [Briumvi™])
Next-Generation Sequencing for the Assessment of Measurable Residual Disease
Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Pegfilgrastim (Neulasta®); Pegfilgrastim-unne ( Armlupeg® ); Pegfilgrastim-pccg (Ennumo™); Pegfilgrastim-jmdb (Fulphila®); Pegfilgrastim-pbbk (Fylnetra®); Pegfilgrastim-apgf (Nyvepria™); Pegfilgrastim-fpgk (Stimufend®); Pegfilgrastim-cbqv (Udenyca®); Pegfilgrastim-bmez (Ziextenzo™)
Pembrolizumab and Berahyaluronidase alfa-pmph (Keytruda Qlex™)
Pemetrexed (Alimta®; Pemfexy™, Pemetrexed™, Pemrydi RTU, Axtle™)
Pertuzumab (Perjeta®); Pertuzumab-dpzb (Poherdy®)
Prostate Cancer Biomarkers Testing
Ranibizumab (Lucentis®); Ranibizumab-nuna [Byooviz™]; Ranibizumab-eqrn [Cimerli™]; Ranibizumab-leyk [Nufymco™]; Ranibizumab-hkdz [Ranluspec®]
Rituximab Products (Rituxan®, Rituximab-abbs [Truxima®], Rituximab-arrx [Riabni™] and Rituximab-pvvr [Ruxience®]), and Rituximab-cdxx [Zimrixby™] - ONCOLOGY
Tocilizumab (Actemra®); Tocilizumab-anoh (Avtozma®); Tocilizumab-bavi (Tofidence™); Tocilizumab-aazg (Tyenne®), tocilizumab-aazg, tocilizumab-anoh
Ustekinumab Products: Ustekinumab (Stelara®); Ustekinumab-auub (Wezlana™); Ustekinumab-srlf (Imuldosa™); Ustekinumab-aauz (Otulfi™); Ustenkinumab-ttwe (Pyzchiva™), Ustekinumab-aekn (Selarsdi™); Ustenkinumab-stba (Steqeyma™); Ustenkinumba-kfce (Yesintek™); ustekinumab; ustekinumab-aauz, ustekinumab-stba, ustekinumab-aekn ; ustekinumab-auub; ustenkinumab-ttwe, Ustekinumab-hmny (Starjemza)
Pharmacy Policies to be Archived on 12/31/2026
Aducanumab-avwa (Aduhelm™) Pharmacy Management is recommending archival of the policy due to drug discontinuation.
C1 Esterase Inhibitor Subcutaneous (Human) Haegarda® Pharmacy Management is recommending archival of the policy due to the medication being managed through the existing pharmacy benefit strategies.
Inotersen (Tegsedi™) Pharmacy Management is recommending archival of the policy due to drug discontinuation.
Topics due to be included in the Medical Policy Manual on 01/01/2027
Commercial & BlueCare PASD Step Therapy Requirements
Last Review Date: 10/19/2026
Please reference the policy name in your comments.
To submit comments about the upcoming Medical policies:
Click the “Medical Policy Comments” above or click here: Comments or Feedback.Please reference the policy name in your comments.
To submit comments about the upcoming Pharmacy policies:
Click the “Pharmacy 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