June 2017
Effective August 1, 2017, BCBSRI moves professional drug reimbursement from the Average Wholesale Price model to the Average Sales Price model, paying drugs for Commercial members at 115% of ASP on August 1, 2017, 110% of ASP on April 1, 2018 and 106% of ASP on April 1, 2019, and drugs for Medicare Advantage members at 106% of ASP on August 1, 2017. Provider-purchased vaccines remain at 95% of AWP, and drugs without a published CMS ASP continue to be paid at 90% of AWP. Effective June 1, 2017, percutaneous electrical nerve stimulation and percutaneous neuromodulation therapy for chronic pain are considered not medically necessary for BlueCHiP for Medicare and Commercial products.