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Blue Cross Blue Shield of Rhode IslandCommercial · 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
Sep 1, 2026

Summary

Effective September 1, 2026, iDose TR (J7355) and Durysta (J7351) will require prior authorization under the medical benefit with mandatory step therapy. 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 and prior authorization workflows to require step therapy documentation for J7355 and J7351.
02Modify authorization rules to verify patient trial and failure of topical prostaglandin analogs before approval.
03Update provider encounter templates and authorization request forms to include step therapy requirements.
04Providers must document prior use of topical prostaglandin analogs in medical record.
05Claims submitted without evidence of step therapy completion will be denied.
06Coordinate with prior authorization vendor and clinical staff to ensure step therapy protocols are in place before the effective date.

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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