Bortezomib (Velcade®; Bortezomib, Boruzu™) coverage
Customize your policy alerts
Sign up for blue cross blue shield - tennessee Policy ID_CHS_2025 alerts
Get alerted when Policy ID_CHS_2025 changes without checking for updates manually.
Monitor payer policy activity
Defines medical necessity, covered indications, authorization durations, dosing limits, and continuation criteria for bortezomib for members of BlueCross BlueShield of Tennessee.
No material clinical or coverage changes in this revision.
Coverage Criteria for Bortezomib
Covered Indications and Authorization Durations
Covered when the indication is one of the FDA‑approved or compendial uses and approval criteria are met.
FDA‑approved
FDA‑approved
compendial use
compendial use
compendial use
compendial use
compendial use
compendial use
compendial use
compendial use
compendial use
compendial use
Continuation/Reauthorization
Covered when ALL of the following are met
Reauthorization allowed when both conditions are met
Indications that are not listed among the FDA-approved or compendial uses for bortezomib are considered experimental/investigational and are not medically necessary. Requests for coverage for such nonlisted indications may be denied.
Off-label uses of FDA-approved drugs, including bortezomib, must be recognized in a statutorily recognized standard reference compendium or supported in the published peer-reviewed medical literature to be eligible for coverage under Tennessee law. Off‑label indications that are not recognized in these sources are not covered.
All other indications for bortezomib that are neither FDA‑approved nor supported by accepted compendial listings are considered experimental/investigational and not medically necessary, and therefore are not covered.
Drug Names and Dosing Limits
| Velcade® | Brand name reference for bortezomib |
| Bortezomib, Boruzu™ | Generic/alternate brand names referenced |
Provider Actions and Prior Authorization
Prior Authorization for Off‑Label Uses
Prior authorization is required for off-label uses of FDA‑approved drugs when the requested indication is not FDA‑approved. Coverage for off‑label indications will only be considered when the use is recognized in a statutorily recognized compendium or is supported by published peer‑reviewed medical literature in accordance with Tennessee Code Annotated Section 56‑7‑2352. Requests for off‑label use should clearly identify the compendial citation or provide relevant peer‑reviewed references.
- Policy effective date: 07/31/2026
- Compendia examples: NCCN Drugs & Biologics Compendium, Drugdex (Micromedex), AHFS Drug Information
Experimental/Investigational Exclusions
All indications not listed as FDA‑approved or recognized by compendia/peer‑reviewed literature are considered experimental/investigational and are not medically necessary. Requests for these indications will be denied.
Off‑Label Use Denial Risk
Off‑label use requests that are not supported by a statutorily recognized compendium or by peer‑reviewed medical literature are at risk of denial. Providers should ensure submitted evidence directly supports the requested indication and place in therapy.
- Requests lacking compendial citation or peer‑reviewed references may be denied
- Ensure literature provided is specific to the requested indication and population
Clinical Documentation and References
Providers must document the regimen, dosage, contraindications, precautions, monitoring plan, and the compendial or literature support for the requested indication. Include prior therapy history, response/toxicity to prior regimens, and rationale for the requested agent and duration.
- Documented regimen and dosage
- Clinical rationale and prior treatment history
- Compendia citations or peer‑reviewed references supporting the indication
Reauthorization Criteria
Reauthorization may be granted for up to 12 months for continued treatment of an indication listed in the coverage criteria when there is no evidence of unacceptable toxicity or disease progression while on the current regimen. Reauthorization requests must include clinical status, objective response measures where applicable, and documentation of toxicity assessment.
- Reauthorization period: up to 12 months
- Required documentation: current disease status, response assessments, toxicity evaluation
Regimen Sequencing
For appropriate chemotherapy regimens and sequencing of therapies, refer to standard reference compendia (e.g., NCCN Guidelines®, Drugdex/Micromedex, AHFS) to determine recommended lines of therapy, combination regimens, and sequencing relative to prior treatments.
- Follow compendia for regimen selection and sequencing
- Document why chosen regimen is appropriate given prior therapies
Line of Therapy and Salvage Use
salvage
Explicitly described as subsequent/salvage therapy for listed indications
Regimens and References
| Guidance | Notes / References |
|---|---|
| Refer to NCCN Clinical Practice Guidelines in Oncology, standard reference compendia (e.g., NCCN Drugs & Biologics Compendium, Drugdex, AHFS, Lexicomp, Micromedex), and product package inserts for specific bortezomib regimens, dosing, contraindications, precautions, warnings, and monitoring. | See 'ADDITIONAL INFORMATION' and 'REFERENCES' sections; examples include the NCCN Guidelines and the Velcade, Boruzu, and bortezomib package inserts (see references). |
Definitions and Dose Ceilings
Background
Bortezomib is an FDA‑approved proteasome inhibitor indicated for multiple myeloma and mantle cell lymphoma. It is also used off‑label for several plasma cell and lymphoid disorders when those uses are supported by recognized compendia; the policy lists multiple compendial indications (e.g., systemic light chain amyloidosis, multicentric Castleman disease, Waldenström macroglobulinemia, and others) and sets related dosing and authorization limits.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.