CommercialAdministrativeMedium impact
Changes being made to the Medical Drug Review program
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Aug 1, 2022
We identified it
Jun 19, 2026
Summary
BCBSRI is making changes to their Medical Drug Review (MDR) program, with Prime Therapeutics continuing to handle prior authorization reviews. The Aduhelm policy is being archived and the specialty pharmacy requirement has been removed, allowing providers to buy and bill directly.
Action Required
Review current Aduhelm billing practices and verify medical policy for updated coverage details. Billing team should note that specialty pharmacy dispensing is no longer required - providers can now buy and bill medications directly under the MDR program. Contact Prime Therapeutics for any prior authorization questions.