Blue Cross Blue Shield - Tennessee Prior Authorization Lookup
- Blue Cross Blue Shield - Tennessee coverage criteria
- All Blue Cross Blue Shield - Tennessee policy updates
Latest Blue Cross Blue Shield - Tennessee prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Inclisiran (Leqvio®)Covers medical necessity and prior-authorization criteria for inclisiran (Leqvio®) as adjunct to diet and exercise to reduce LDL-C for specified FDA‑approved indications; applies to Blue Cross Blue Shield - Tennessee members and prescribing providers.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Secukinumab (Cosentyx) — Coverage CriteriaMedical policy governing prior authorization, coverage criteria, and documentation requirements for secukinumab (Cosentyx) for FDA‑approved indications and compendial uses for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Carfilzomib (Kyprolis) — Coverage Criteria for Multiple Myeloma and Related Plasma Cell DisordersCovers medical necessity criteria, dosing limits, and prior authorization requirements for Kyprolis (carfilzomib) for multiple myeloma and related plasma cell disorders for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Daratumumab (Darzalex) — Coverage CriteriaDefines prior authorization, coverage criteria, and authorization durations for daratumumab (Darzalex) across FDA-approved and compendial oncology indications for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Evenity (romosozumab) — Coverage Criteria for Postmenopausal OsteoporosisCovers prior authorization, coverage criteria, and limitations for Evenity (romosozumab) for treatment of osteoporosis in postmenopausal women at high risk for fracture for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Evinacumab (Evkeeza) for Homozygous Familial Hypercholesterolemia — Coverage CriteriaCovers prior authorization, clinical criteria, and continuation requirements for evinacumab (Evkeeza) as adjunct therapy to lower LDL-C in patients with homozygous familial hypercholesterolemia (HoFH) for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Inclisiran (Leqvio) — Coverage Criteria for HypercholesterolemiaThis policy governs prior authorization, coverage criteria, and documentation requirements for inclisiran (Leqvio) to reduce LDL-C in adults with hypercholesterolemia, including heterozygous familial hypercholesterolemia, for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Lamzede (velmanase alfa) for alpha-mannosidosis — Coverage CriteriaCovers use of Lamzede for treatment of non‑central nervous system manifestations of alpha‑mannosidosis for Blue Cross Blue Shield of Tennessee members when authorization criteria are met; applies to providers seeking prior authorization and continued therapy.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Lanreotide (Somatuline® Depot) coverageDefines prior authorization, coverage criteria, and documentation requirements for lanreotide (Somatuline® Depot) for FDA‑approved and compendial indications for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Octreotide (Sandostatin LAR) injectable suspension — Coverage CriteriaDefines coverage, prior authorization requirements, and clinical indications for Sandostatin LAR (octreotide acetate for injectable suspension) for Blue Cross Blue Shield Tennessee members when approval criteria are met.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Pasireotide (Signifor LAR) — Coverage CriteriaDefines prior authorization, documentation, and coverage criteria for pasireotide (Signifor LAR) for treatment of acromegaly and Cushing's disease for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Rivfloza (for primary hyperoxaluria type 1) Coverage CriteriaPolicy governs coverage and prior authorization requirements for Rivfloza to lower urinary oxalate in patients with primary hyperoxaluria type 1 (PH1) with preserved kidney function; affects providers prescribing the drug and BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Skysona (gene therapy) for cerebral adrenoleukodystrophy (CALD)Covers medical necessity criteria, prior authorization, documentation, exclusions, and monitoring requirements for use of Skysona in boys with early, active cerebral adrenoleukodystrophy (CALD) for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Spesolimab-sbzo (SpevigoPolicy defines prior authorization criteria, documentation requirements, prescribing specialty, and coverage durations for spesolimab (Spevigo) for treatment of generalized pustular psoriasis (GPP) in patients aged 12 years and older weighing at least 40 kg. It excludes non-FDA-approved indications as investigational.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31Zynyz (pembrolizumab?) — indications for select solid tumorsDefines coverage and prior authorization requirements for Zynyz for specified cancer indications and biomarker-driven uses for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-31iDose TR (travoprost intracameral implant) — Coverage Criteria and Prior AuthorizationPolicy governing prior authorization, coverage criteria, continuation, and exclusions for iDose TR for reduction of intraocular pressure in patients with open-angle glaucoma or ocular hypertension for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Enhertu (fam-trastuzumab deruxtecan‑nxki) — Coverage CriteriaThis policy governs prior authorization, coverage criteria, and quantity limits for Enhertu (fam-trastuzumab deruxtecan-nxki) for Blue Cross Blue Shield - Tennessee members for specified HER2-related oncologic indications.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Intravenous Immune Globulin (IVIG)Defines coverage, documentation, and prior authorization criteria for IVIG products for Blue Cross Blue Shield - Tennessee members, including FDA-approved and compendial indications and clinical requirements for authorization.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Onasemnogene Abeparvovec-xioi (Zolgensma®)Defines coverage and prior authorization criteria for a single total dose of onasemnogene abeparvovec-xioi (Zolgensma) for treatment of pediatric spinal muscular atrophy (SMA) in members, including required documentation, laboratory and genetic tests, exclusion criteria, and prescriber specialty.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Opdivo Qvantig (nivolumab biosimilar) — Coverage CriteriaThis policy describes indications, prior authorization requirements, documentation, exclusions, and authorization durations for Opdivo Qvantig for Blue Cross Blue Shield of Tennessee members. It applies to providers requesting coverage for the listed oncology indications when approval criteria are met.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Rituximab Products (Rituxan®, Truxima®, Riabni™, Ruxience®) — Non‑Oncology IndicationsThis policy governs coverage and prior authorization requirements for rituximab products (Rituxan, Truxima, Riabni, Ruxience) when used for non-oncology indications such as rheumatoid arthritis, vasculitides, autoimmune neurologic and dermatologic diseases, and transplant-related uses for Blue Cross Blue Shield Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Tecentriq (atezolizumab) — coverage criteria for oncology indicationsPolicy governs coverage and prior authorization criteria for Tecentriq (atezolizumab) for approved and compendial oncology indications for Blue Cross Blue Shield - Tennessee members.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Tezepelumab (Tezspire) — Coverage Criteria for Severe Asthma and CRSwNPCovers medical necessity, prior authorization, and coverage criteria for Tezepelumab (Tezspire) as add-on maintenance therapy in members aged 12 and older with severe asthma or chronic rhinosinusitis with nasal polyps (CRSwNP) for BlueCross BlueShield of Tennessee.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)Defines coverage, prior authorization, quantity limits, and treatment duration for Herceptin Hylecta (subcutaneous trastuzumab with hyaluronidase) for BCBS Tennessee members with HER2-positive breast cancer and specified compendial uses.All blue cross blue shield - tennessee updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-30Ustekinumab Products (Stelara and biosimilars) — Coverage and Prior Authorization CriteriaCoverage and prior authorization criteria for ustekinumab products for FDA‑approved and compendial indications for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
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Tool Description
Search Blue Cross Blue Shield - Tennesseeprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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