Medicare AdvantageCoverageHigh impact
2025 pharmacy changes
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island is implementing significant 2025 pharmacy formulary changes for Medicare members, with 470 drugs being removed from formulary and 936 drugs moving to higher cost tiers. Members affected by negative changes will receive 90-day transition fills and can request coverage exceptions.
Action Required
By January 1, 2025: Billing team and providers must review patient medication lists against new formulary changes. For drugs moved off formulary, switch members to covered alternatives or request coverage exceptions through Prime Therapeutics using CoverMyMeds portal. Submit 2025 exception reviews (available starting November 1, 2024). Inform affected Medicare members about 90-day transition fill eligibility. Update patient counseling procedures to address potential medication cost increases due to tier changes.