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Changes being made to the Medical Drug Review (MDR) program
Act
by Apr 1, 2022
Effective date
Apr 1, 2022
Identified
Jun 19, 2026
Summary
BCBSRI is adding step therapy requirements for three injection codes (J3032 Vepto, J1950 Lupron Depot) effective April 1, 2022. Specific alternative medications must be tried before these drugs will be covered, with prior authorization handled by Prime Therapeutics.
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What to do
by Apr 1, 2022 · 6 steps
01Billing team must update prior authorization procedures for J3032 (Vepto) and J1950 (Lupron Depot) to include step therapy requirements.
02For J3032, patients must try Aimovig, Emgality, or Ajovy first.
03For J1950 doses 3.75mg and 11.25mg, patients must try Zoladex or Trelstar first.
04For J1950 doses 7.5mg, 11.25mg, 15mg, and 30mg, patients must try Trelstar first.
05Contact Prime Therapeutics for all prior authorization requests.
06Note that J9217, J3316, and J9202 codes for specific GnRH medications continue without prior authorization requirements.
Codes mentioned
J3032J1950J9217J3316J9202
Original notice
Changes being made to the Medical Drug Review (MDR) program
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Drugs moving from the specialty pharmacy benefit to the medical benefit 4/1/21HighEffective Apr 1, 2021 · PhysicianMedical drug review updates effective April 1, 2022MediumEffective Apr 1, 2022 · Physician / FacilityCPT code changesMediumEffective Oct 1, 2020 · Physician / FacilityMDR Changes effective 7/01/2021HighEffective Jul 1, 2021 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list