CommercialPrior AuthHigh impact
Commercial BlueCare PAD_Step Therapy Guide
BCBS Tennessee·TN · Oncology, Rheumatology, Neurology +6 more·Government Programs
Effective date
Jul 1, 2026
We identified it
Jun 17, 2026
Summary
BlueCare Tennessee has implemented new step therapy requirements for provider-administered specialty drugs effective July 1, 2026. Providers must try preferred alternative medications before using requested specialty drugs across multiple therapeutic categories including autoimmune conditions, oncology, growth factors, and more.
Action Required
By July 1, 2026: Billing team must update prior authorization workflows to ensure preferred alternative medications are tried first before billing for specialty drugs listed in the step therapy requirements. Update clinical protocols to document failed trials of preferred agents. Train providers on new step therapy sequences for each therapeutic category. Implement system alerts for affected J-codes and Q-codes to prompt step therapy compliance. Failure to follow step therapy may result in claim denials.