Drug Prior Authorization Policies

BlueCross BlueShield of Tennessee pharmacy policies are based on (1) information in FDA approved package inserts (and black box warnings, alerts, or other information disseminated by the FDA as applicable); (2) research of current medical and pharmacy literature; and/or (3) review of common medical practices in the treatment and diagnosis of disease as of the date hereof.

Note: coverage is subject to member’s specific benefits. Group specific policies will supersede these policies when applicable. Please refer to member’s benefit plan. The purpose of BlueCross BlueShield of Tennessee’s pharmacy policies is to provide a guide to coverage. Pharmacy policies are not intended to dictate to physicians how to practice medicine. Physicians should exercise their medical judgment in providing the care they feel is most appropriate for their patients.

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A health plan with a Medicare contract.
H7917_W10_R2 CMS Approved 01042010
A Medicare approved Part D sponsor.
S1030_W10_R2 CMS Approved 01042010

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