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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
Not stated
We identified it
Jun 19, 2026
Days to comply
—

Summary

Blue Cross & Blue Shield of Rhode Island is making changes to their Medical Drug Review (MDR) program for prescription drugs covered under medical benefits. Prior authorization reviews will continue to be handled by Prime Therapeutics, with drug-specific criteria available through their provider portal.

Action Required

Action needed
Review current prior authorization processes for prescription drugs covered under medical benefits with BCBSRI. Verify that staff know to contact Prime Therapeutics for prior authorization reviews and bookmark the Prime Therapeutics provider portal for drug-specific criteria. Monitor for additional details about specific MDR program changes that may affect billing workflows.

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