All PlansPrior AuthMedium impact
Provider notification: iDose TR (J7355) and Durysta (J7351)
Blue Cross Blue Shield of Rhode Island·RI · Ophthalmology·Physician / Facility
Effective date
Sep 1, 2026
We identified it
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.
Action Required
By August 31, 2026: Billing team must update billing system to flag claims for J7355 and J7351 as requiring prior authorization. Update claim submission workflows to mandate step therapy verification (documented trial and failure of topical prostaglandin analogs) before authorization request submission. Notify providers and clinical staff that these injectable glaucoma medications now require prior auth and step therapy documentation. Train front-desk and authorization staff on new requirements. Starting September 1, 2026, do not submit claims for J7355 or J7351 without prior authorization approval. Claims submitted without prior auth will be denied.