Medicare AdvantageCoverageMedium impact
2026 pharmacy changes
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island is implementing significant Medicare formulary changes for 2026, with 31 drugs being removed from coverage and 15 drugs moving to higher cost tiers. Members will have access to transition fills for 90 days and coverage exception processes through Prime Therapeutics.
Action Required
Before January 1, 2026: Clinical staff must review current Medicare patient medication lists to identify those affected by formulary changes. For patients on the 31 removed drugs, work with providers to switch to covered alternatives or submit coverage exceptions through Prime Therapeutics (CoverMyMeds portal). Inform affected patients they can receive transition fills during the first 90 days of 2026. Exception requests can be submitted starting November 1, 2025.