CommercialPrior AuthMedium impact
Changes are being made to the Medical Drug Review (MDR) program
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Dec 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI is making changes to their Medical Drug Review (MDR) program, which affects prescription drugs covered under the medical benefit. Prior authorization reviews will continue to be handled by Prime Therapeutics, and providers should refer to updated drug criteria for authorization details.
Action Required
Immediately: Billing and clinical teams must review updated drug criteria in the provider administered medication criteria section at Prime Therapeutics' prior authorization portal (myprime.com). Update workflows to ensure proper prior authorization is obtained for affected medications before administration. Monitor for specific drug formulary changes that may require prior authorization.