CommercialPrior 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
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.
Action Required
By August 31, 2026: Billing team must update billing system and prior authorization workflows to require step therapy documentation for J7355 and J7351. Modify authorization rules to verify patient trial and failure of topical prostaglandin analogs before approval. Update provider encounter templates and authorization request forms to include step therapy requirements. Providers must document prior use of topical prostaglandin analogs in medical record. Claims submitted without evidence of step therapy completion will be denied. Coordinate with prior authorization vendor and clinical staff to ensure step therapy protocols are in place before the effective date.