CommercialPrior AuthMedium impact
MDR Updates effective December 1, 2025
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Dec 1, 2025
We identified it
Jun 19, 2026
Summary
Starting December 1, 2025, all new drugs entering the market will require prior authorization for commercial insurance plans only. This policy specifically applies to pharmacy-related billing and does not affect Medicare or Medicaid plans.
Action Required
By December 1, 2025: Billing team must update prior authorization workflows to include all new-to-market drugs for commercial plans only. Verify prior auth requirements before dispensing any newly released medications to commercial patients. Claims for new drugs without prior authorization will be denied.