← Back to list
Benefit Coverage Change for Medications
Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Aug 19, 2026
Summary
Effective October 1, 2026, BCBSRI is transitioning coverage for six specialty medications (Signifor LAR, Aralast NP, Glasssia, Prolastin-C, Zemaira) from the pharmacy benefit to the medical benefit. These medications will now require prior authorization through GatewayPA under the medical benefit instead of being processed as pharmacy claims.
Get alerts when payers change rules like this one
We check Blue Cross Blue Shield of Rhode Island and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross Blue Shield of Rhode Island alertsPolicy Monitoring is free. No card required.
What to do
by Sep 15, 2026 · 7 steps
01Billing team must implement the following changes.
02Update billing system rules to identify Signifor LAR, Aralast NP, Glasssia, Prolastin-C, and Zemaira claims and route them to the medical benefit instead of pharmacy benefit.
03Configure system to automatically flag these medications for prior authorization requirement through GatewayPA.
04Update provider ordering workflows and encounter documentation templates to alert prescribers that these medications now require medical prior authorization.
05Train front desk and billing staff on the new submission process via GatewayPA portal.
06Failure to obtain prior authorization before service delivery will result in claim denials and payment delays.
07Coordinate with providers to ensure prescriptions written on or after October 1, 2026 include prior authorization requests.
Original notice
Benefit Coverage Change for Medications
bcbsri.com · Always check the source before changing claims.