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
BCBS Rhode Island is implementing a new prior authorization process for certain specialty drugs under the medical benefit, effective May 1, 2026. Providers must begin using Prime's Medical Pharmacy Solutions team and the GatewayPA.com platform instead of CoverMyMeds/fax for in-scope drugs starting April 24, 2026.
Action Required
By April 24, 2026: Medical billing team must transition from CoverMyMeds/fax system to GatewayPA.com platform for prior authorizations of specialty drugs under medical benefit. Call 1-833-895-8282 for phone submissions. Attend training webinars on April 13 or April 20, 2026. Continue using CoverMyMeds/fax only for patient self-administered drugs. Update workflow procedures and train staff on new platform to avoid claim denials.