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Blue Cross Blue Shield of Rhode IslandAll Plans · Prior Auth · Physician / Facility · RI · OphthalmologyMedium impact

Provider notification: iDose TR (J7355) and Durysta (J7351)

Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Aug 1, 2026

Summary

Effective September 1, 2026, iDose TR (J7355) and Durysta (J7351) will require prior authorization under the medical benefit with step therapy requirements. Patients must first trial and fail topical prostaglandin analogs (e.g., Travoprost eye drops) before these drugs can be approved.

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What to do

by Aug 31, 2026 · 6 steps
01Billing team must update billing system to flag claims for J7355 and J7351 as requiring prior authorization.
02Update claim submission workflows to mandate step therapy verification (documented trial and failure of topical prostaglandin analogs) before authorization request submission.
03Notify providers and clinical staff that these injectable glaucoma medications now require prior auth and step therapy documentation.
04Train front-desk and authorization staff on new requirements.
05Starting September 1, 2026, do not submit claims for J7355 or J7351 without prior authorization approval.
06Claims submitted without prior auth will be denied.

Codes mentioned

J7355J7351

Original notice

Provider notification: iDose TR (J7355) and Durysta (J7351)
bcbsri.com · Always check the source before changing claims.
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Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
Provider notification: iDose TR (J7355) and Durysta (J7351)MediumEffective Sep 1, 2026 · Physician / FacilityProvider Notification: iDose TR (J7355) and Durysta (J7351)MediumEffective Sep 1, 2026 · Physician / FacilityAdditional HCPCS Level II Code Changes and Modifier ChangesHighEffective Jul 1, 2024 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list

Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesOphthalmologyCode J7355Code J7351

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