CommercialPrior AuthHigh impact
Reminder: Pharmacy post-claim review medications effective May 1, 2026
Blue Cross Blue Shield of Rhode Island·RI · Pharmacy·Provider Update
Effective date
May 1, 2026
We identified it
Jul 1, 2026
Summary
BCBS Rhode Island is implementing a new pharmacy post-claim review process for in-scope medications effective May 1, 2026. Providers must now obtain prior authorizations through a new platform (GatewayPA.com) or by phone (1-833-895-8282) for medical benefit drugs with dates of service on or after May 1, 2026, while self-administered drugs continue through CoverMyMeds and fax.
Action Required
By April 30, 2026: Providers and billing staff must register and become familiar with GatewayPA.com platform for submitting prior authorization requests for in-scope pharmacy drugs. Billing team must update internal workflows and provider alerts to route all medical benefit drug prior authorizations to GatewayPA.com or phone 1-833-895-8282 (no longer use standard channels for these drugs). Obtain the specific list of in-scope drugs from BCBS Rhode Island's Pharmacy Post Claim Review Medications Payment Policy and update billing system rules accordingly. Continue routing self-administered drug requests through CoverMyMeds and fax. Beginning May 1, 2026, all prior authorization requests for in-scope drugs submitted through old channels will be rejected, potentially causing claim denials and payment delays. Communicate this change to all providers in your network immediately.