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 08/30/2025
Topics due to be included in the Medical Policy Manual on 09/30/2025
Topics due to be included in the Medical Policy Manual on 10/31/2025
Topics due to be included in the Medical Policy Manual on 08/30/2025
Daratumumab and hyaluronidase-fihj (Darzalex Faspro®)
Etranacogene Dezaparvovec-drlb (Hemgenix®)
Negative Pressure Wound Therapy in the Outpatient Setting
Nivolumab/Relatlimab-rmbw (Opdualag™)
Octreotide Suspension (Sandostatin® LAR Depot), Octreotide Acetate for Injectable Suspension
Pharmacogenetic Testing for Pain Management
Prademagene Zamikeracel (Zevaskyn™)
Revakinagene Taroretcel-lwey (Encelto™)
Talimogene Laherparepvec (Imlygic™)
Telisotuzumab vedotin-tllv (Emrelis™)
Topics due to be included in the Medical Policy Manual on 09/30/2025
Abraxane® (paclitaxel, albumin-bound) paclitaxel, albumin-bound
Alpha-1 Proteinase Inhibitor (Aralast NP®, Glassia®, Prolastin-C®, Zemaira®)
Beremagene Geperpavec-svdt (Vyjuvek™)
Cipaglucosidase Alfa-atga (Pombiliti™)
Circulating Tumor DNA (Liquid Biopsy)
Complementary and Alternative Medicine
Pertuzumab, Trastuzumab and Hyaluronidase-zzxf (Phesgo™)
Romidepsin [Istodax®; Romidepsin (liquid)]
Sacituzumab Govitecan-hziy (Trodelvy®
Temozolomide (Temodar®), temozolomide
Vestronidase Alfa-vjbk (Mepsevii®)
Voretigene Neparvovec-rzyl (Luxturna®)
Medical policies to be Archived on 09/30/2025:
Remdesivir (Veklury®) as an Outpatient Treatment of COVID-19 - Pharmacy plans to archive due to decreased utilization and broader clinical experience.
Topics due to be included in the Medical Policy Manual on 10/31/2025
Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza™)
DaxibotulinumtoxinA-lanm (Daxxify™)
Delandistrogene moxeparvovec-rokl (Elevidys®)
Efgartigimod Alfa-fcab Products
Fam-trastuzumab Deruxtecan-nxki (Enhertu®)
Histrelin Acetate (Supprelin® LA)
Intravenous Immune Globulin (IVIG)
Leuprolide Acetate (Fensolvi®)
Leuprolide Suspension (Lupron Depot-Ped®)
Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Ocrelizumab (Ocrevus™) Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo)
RimabotulinumtoxinB (Myobloc®)
Treatment for Sexual Dysfunction in Males: Non-Pharmacologic
Last Review Date: 8/14/2025
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