CommercialPrior AuthHigh impact
Provider Notice: Benefit Coverage Change
Blue Cross Blue Shield of Rhode Island·RI · Pharmacy, Internal Medicine, Pulmonology +2 more·Physician / Facility
Effective date
Oct 1, 2026
We identified it
Sep 1, 2026
Summary
Effective October 1, 2026, BCBSRI is moving coverage for six specialty medications (Signifor LAR, Aralast NP, Glassia, Prolastin-C, Zemaira) from the pharmacy benefit to the medical benefit. All prior authorization requests for these drugs must now be submitted through GatewayPA as medical benefit requests rather than pharmacy requests.
Action Required
By September 30, 2026: Billing team must update all internal workflows and billing system edits to reclassify Signifor LAR, Aralast NP, Glassia, Prolastin-C, and Zemaira claims from pharmacy benefit to medical benefit billing. Providers and billing staff must be trained to submit prior authorization requests for these medications through GatewayPA using medical benefit prior auth procedures, not pharmacy prior auth procedures. Update encounter templates and pharmacy/clinical staff communication protocols to reflect the benefit change. After October 1, 2026, any claims submitted under the pharmacy benefit for these medications will likely be denied; ensure all claims route to medical benefit processing with required prior authorization.