CommercialPrior AuthMedium impact
Medical drug review updates effective April 1, 2022
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Urology, Endocrinology +1 more·Physician / Facility
Effective date
Apr 1, 2022
We identified it
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.
Action Required
Immediately: Billing team must verify that J9217 (Lupron Depot/Eligard), J3316 (Trelstar), and J9202 (Zoladex) do NOT require prior authorization in billing system for BCBSRI patients. Remove any prior auth requirements for these specific GnRH codes. Continue processing prior authorization requests through Prime Therapeutics for all other medical drugs requiring review.