CommercialPrior AuthMedium impact
Provider Notification: iDose TR (J7355) and Durysta (J7351)
Blue Cross Blue Shield of Rhode Island·RI · Ophthalmology, Optometry·Physician / Facility
Effective date
Sep 1, 2026
We identified it
Jul 1, 2026
Summary
Effective September 1, 2026, iDose TR (J7355) and Durysta (J7351) will require prior authorization under the medical benefit and are subject to Step Therapy, requiring documented trial and failure of topical prostaglandin analogs (e.g., Travoprost eye drops) before approval. This is a Blue Cross Blue Shield Rhode Island (BCBS RI) policy affecting these two glaucoma/ocular hypertension medications.
Action Required
By August 15, 2026: Billing team must update billing software and prior authorization workflows to require prior authorization for J7355 (iDose TR) and J7351 (Durysta). Implement Step Therapy validation logic requiring documented evidence of trial and failure of topical prostaglandin analogs (such as Travoprost) before these codes can be approved. Update encounter forms and provider order entry systems to include Step Therapy documentation requirements. Train providers and clinical staff on the new authorization process. Beginning September 1, 2026: Do not submit claims for J7355 or J7351 without first obtaining prior authorization. Claims submitted without prior authorization will be denied. Verify Step Therapy compliance documentation is attached to all prior authorization requests.