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Provider notice: Benefit coverage change
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Oct 1, 2026
Summary
Effective October 1, 2026, BCBSRI is moving coverage for six specific 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 using the medical benefit process instead of pharmacy benefit procedures.
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What to do
by Sep 30, 2026 · 5 steps
01Billing team must update billing system workflows to reroute claims for Signifor LAR, Aralast NP, Glassia, Prolastin-C, and Zemaira from pharmacy billing to medical benefit billing.
02Prior to October 1, 2026, train all staff submitting prior authorization requests to use GatewayPA for medical benefit prior auth (not pharmacy channels) for these five medications.
03Update internal billing guidelines and provider documentation templates.
04Beginning October 1, 2026, any claims submitted under the pharmacy benefit for these medications will likely be denied or require rework.
05Verify GatewayPA system access for all staff who will submit medical prior authorizations.
Original notice
Provider notice: Benefit coverage change
bcbsri.com · Always check the source before changing claims.