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Prior Authorization Criteria: BlueCross BlueShield of Tennessee

Clinical Criteria

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Select the starting letter of the medication name or class to find the desired form.

Drug coverage is dependent on member's formulary and plan benefits. Prior authorization requests are subject to the coverage criteria outlined by the plan and, if approved, may be granted for a duration of up to 12 months.

A

Glossary list of letter A

B

Glossary list of letter B

C

Glossary list of letter C

D

Glossary list of letter D

E

Glossary list of letter E

F

Glossary list of letter F

G

Glossary list of letter G

H

Glossary list of letter H

I

Glossary list of letter I

J

Glossary list of letter J

K

Glossary list of letter K

L

Glossary list of letter L

M

Glossary list of letter M

N

Glossary list of letter N

O

Glossary list of letter O

P

Glossary list of letter P

Q

Glossary list of letter Q

R

Glossary list of letter R

S

Glossary list of letter S

T

Glossary list of letter T

U

Glossary list of letter U

V

Glossary list of letter V

W

Glossary list of letter W

X

Glossary list of letter X

Y

Glossary list of letter Y

Z

Glossary list of letter Z