CommercialPrior AuthMedium impact
Changes are being made to the Medical Drug Review (MDR) program
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Rheumatology, Gastroenterology +5 more·Physician / Facility
Effective date
Nov 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI is making changes to their Medical Drug Review (MDR) program for prescription drugs covered under medical benefits. Prime Therapeutics will continue handling all existing and new prior authorization reviews for provider-administered medications.
Action Required
Immediately: Billing team should review current provider-administered medication prior authorization procedures and ensure they are following Prime Therapeutics guidelines. Verify all prior authorizations for injectable medications and infusions are being processed through Prime Therapeutics system at myprime.com before scheduling treatments.