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Provider Notice: Benefit Coverage Change
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
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.
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What to do
by Sep 30, 2026 · 4 steps
01Billing 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.
02Providers 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.
03Update encounter templates and pharmacy/clinical staff communication protocols to reflect the benefit change.
04After 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.
Original notice
Provider Notice: Benefit Coverage Change
bcbsri.com · Always check the source before changing claims.