CommercialPrior AuthHigh impact
Pharmacy post-claim review medications effective May 1, 2026
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
May 1, 2026
We identified it
Jun 19, 2026
Summary
BCBSRI is implementing a new prior authorization workflow for specialty drugs under medical benefit effective May 1, 2026. Providers must switch from CoverMyMeds/fax submissions to using GatewayPA.com or calling Prime's Medical Pharmacy Solutions team for in-scope drugs.
Action Required
Before May 1, 2026: Billing team and providers must transition prior authorization requests for BCBSRI specialty drugs from CoverMyMeds/fax to GatewayPA.com or phone 1-833-895-8282. Update workflow procedures to direct staff to new platform for in-scope drugs (list available in BCBSRI Pharmacy Post Claim Review Medications Payment Policy). Self-administered patient drugs continue using current CoverMyMeds/fax process.