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 changing the prior authorization process for specialty drugs under medical benefit, requiring providers to use Prime's Medical Pharmacy Solutions team via GatewayPA.com or phone starting April 24, 2026 for services on/after May 1, 2026. This replaces the current CoverMyMeds/fax workflow for in-scope drugs.
Action Required
By April 24, 2026: Billing and clinical staff must transition from CoverMyMeds/fax to GatewayPA.com or phone (1-833-895-8282) for prior authorizations of BCBSRI specialty drugs under medical benefit. Register for training webinars on April 13 at 9 AM or April 20 at 12 PM. Review the Pharmacy Post Claim Review Medications Payment Policy for specific drug list. Self-administered patient drugs continue using current CoverMyMeds/fax process.