CommercialPrior AuthMedium impact
Changes being made to the pharmacy prior authorization (PA) program effective 10/1/24
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Oct 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI is making changes to their pharmacy prior authorization (PA) program effective October 1, 2024, affecting Commercial formularies including Traditional, 4 Tier, 5 Tier, 5 Tier Specialty, 5 Tier Generic, and 6 Tier Flex formularies. The policy indicates certain drugs will be covered on a preferred tier, though the specific drug list was not included in the provided content.
Action Required
By October 1, 2024: Billing and pharmacy teams must review updated BCBSRI Commercial formulary lists to identify which drugs now require prior authorization versus those moved to preferred tiers. Contact BCBSRI or check their provider portal for the complete drug list affected by these PA changes. Update internal pharmacy reference materials and alert providers to new PA requirements to avoid prescription delays.