All PlansCoverageMedium impact
Provider Notification: Apretude® (cabotegravir) Benefit Change
Blue Cross Blue Shield of Rhode Island·RI · Infectious Disease, Family Medicine, Internal Medicine·Physician / Facility
Effective date
Feb 26, 2026
We identified it
Jun 19, 2026
Summary
Effective February 26, 2026, Apretude® (cabotegravir) will transition from being billed under the medical benefit to the pharmacy (Rx) benefit. This means providers can no longer submit medical claims for Apretude® - it must be dispensed through retail or specialty pharmacies instead.
Action Required
Before February 26, 2026: Billing team must stop submitting medical benefit claims for Apretude® (cabotegravir). Update billing system to remove Apretude® from medical benefit procedures. Inform providers that patients must obtain Apretude® through retail or specialty pharmacies going forward. Update patient education materials to reflect pharmacy dispensing process.