CommercialPrior AuthMedium impact
MDR Updates effective November 1, 2025
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Beginning October 1, 2025, certain drugs will require prior authorization for both Commercial and Medicare plans. Additional drugs new to the market will also require prior auth effective November 1st or December 1st, 2025.
Action Required
By October 1, 2025: Billing team must update system to flag drugs requiring prior authorization for Commercial and Medicare patients. Contact insurance plans to obtain prior auth before prescribing affected medications. Monitor for additional drug list updates effective November 1st and December 1st. Claims will be denied without proper prior authorization.