← Back to list
Medical drug review updates effective April 1, 2022
Act
immediately
Effective date
Apr 1, 2022
Identified
Jun 19, 2026
Summary
BCBSRI updated their medical drug review program effective April 1, 2022, continuing prior authorization reviews through Prime Therapeutics. Specific Gonadotropin Releasing Hormone (GnRH) drugs will continue to be covered WITHOUT requiring prior authorization.
Get alerts when payers change rules like this one
We check Blue Cross Blue Shield of Rhode Island and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross Blue Shield of Rhode Island alertsPolicy Monitoring is free. No card required.
What to do
immediately · 3 steps
01Billing team must verify that J9217 (Lupron Depot/Eligard), J3316 (Trelstar), and J9202 (Zoladex) do NOT require prior authorization in billing system for BCBSRI patients.
02Remove any prior auth requirements for these specific GnRH codes.
03Continue processing prior authorization requests through Prime Therapeutics for all other medical drugs requiring review.
Codes mentioned
J9217J3316J9202
Original notice
Medical drug review updates effective April 1, 2022
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Changes being made to the Medical Drug Review (MDR) programMediumEffective Apr 1, 2022 · Physician / FacilityDrugs moving from the specialty pharmacy benefit to the medical benefit 4/1/21HighEffective Apr 1, 2021 · PhysicianMDR Changes effective 7/01/2021HighEffective Jul 1, 2021 · Physician / FacilityMDR Changes effective 8/01/2021HighEffective Aug 1, 2021 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list