Medical Exclusions Drug List
Lists provider-administered drugs that are excluded from medical benefit coverage for Commercial and Marketplace members of Blue Cross Blue Shield - Tennessee. Applies only to Commercial and Marketplace lines; references other manuals for covered products and prior authorization details.
No material clinical or coverage changes.
Policy Summary
Subject: Provider-Administered Pharmacy Products Exclusion List. Payer: Blue Cross Blue Shield - Tennessee. This list identifies provider-administered drugs that are excluded from coverage under the medical benefit for Commercial and Marketplace members.
Scope summary: Lists provider-administered drugs excluded from the medical benefit for Commercial and Marketplace members. Applies only to those lines of business and does not apply to other lines. For information on which provider-administered drugs are covered and any prior authorization requirements, providers should consult the insurer's Medical Policy Manual or the Provider-Administered Specialty Pharmacy Products list.