CommercialPrior AuthMedium impact
Medical Drug Review update for March 1, 2023
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Mar 1, 2023
We identified it
Jun 19, 2026
Summary
BCBSRI is updating their Medical Drug Review (MDR) program effective March 1, 2023, with changes to prescription drug coverage under their medical benefit. Prior authorization reviews will continue to be handled by Prime Therapeutics, their pharmacy benefits manager.
Action Required
By March 1, 2023: Billing team should verify that all medical drug prior authorization requests continue to be submitted to Prime Therapeutics as the pharmacy benefits manager. Monitor for any changes to covered drug lists that may affect medical benefit drug claims and ensure proper prior authorization is obtained before administering covered medications.