BlueCross BlueShield of Tennessee Administrative Services

Provider-Administered Specialty Pharmacy Product Review Policy


The purpose of this document is to establish a policy for the completion of a New Drug Therapy Review prior to the coverage of new to market provider-administered specialty pharmacy products.  Following approval of a provider-administered specialty pharmacy product by the Food and Drug Administration, the Pharmacy and Therapeutics (P&T) Committees engage in a New Drug Therapy Review. This Review evaluates the product’s effectiveness, safety, and affordability and determines coverage parameters and a utilization management strategy. 

Specialty pharmacy products are those products that require in-depth patient teaching, coordination of care, and frequent monitoring to ensure successful use.  They are described by at least one of the following:


All new to market provider-administered specialty pharmacy products will be excluded from coverage until the P&T committees complete the New Drug Therapy Review.  Once the New Drug Therapy Review is complete, provider-administered specialty pharmacy products may move to a covered status.  A provider-administered specialty pharmacy product is not covered unless and until it is included on BCBST’s online list of provider-administered specialty pharmacy products, which as of the effective date of this policy is available at





This document has been classified as public information.