CommercialPrior AuthMedium impact
MDR Updates effective August 1, 2025
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Aug 1, 2025
We identified it
Jun 19, 2026
Summary
Beginning August 1, 2025, certain drugs will require prior authorization for Commercial insurance plans only. This is a pharmacy-related change that affects medication prescribing and billing workflows.
Action Required
By August 1, 2025: Clinical and billing teams must update prior authorization workflows for affected drugs on Commercial plans only. Update EMR templates to flag prior auth requirements for pharmacy benefits. Verify drug formularies in prescribing systems. Claims for affected drugs without prior authorization will be denied.