CommercialPrior AuthMedium impact
Changes being made to the Medical Drug Review (MDR) program
Blue Cross Blue Shield of Rhode Island·RI · Neurology, Oncology, Endocrinology +1 more·Physician / Facility
Effective date
Apr 1, 2022
We identified it
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.
Action Required
By April 1, 2022: Billing team must update prior authorization procedures for J3032 (Vepto) and J1950 (Lupron Depot) to include step therapy requirements. For J3032, patients must try Aimovig, Emgality, or Ajovy first. For J1950 doses 3.75mg and 11.25mg, patients must try Zoladex or Trelstar first. For J1950 doses 7.5mg, 11.25mg, 15mg, and 30mg, patients must try Trelstar first. Contact Prime Therapeutics for all prior authorization requests. Note that J9217, J3316, and J9202 codes for specific GnRH medications continue without prior authorization requirements.