CommercialCoverageHigh impact
BCBSRI formulary changes effective October 1, 2021
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Oct 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI implemented significant formulary changes effective October 1, 2021, excluding coverage for many brand name drugs with generic equivalents, moving numerous medications to higher copay tiers, and requiring prior authorization for specific drugs including AUBAGIO, GILENYA, KESIMPTA, RINVOQ, and others. These changes affect all commercial BCBSRI products but do not apply to BlueCHiP for Medicare plans.
Action Required
Immediately: Update pharmacy benefit management systems to reflect formulary exclusions for brand drugs with generic equivalents (AZOPT, BEPREVE, BROVANA NEB, TRUVADA, etc.). Configure prior authorization requirements for AUBAGIO, GILENYA, KESIMPTA, RINVOQ, SUPPRELIN LA, and ZEPOSIA. Update tier assignments for over 100 medications moving to higher copay tiers. Notify prescribing providers of coverage changes and preferred alternatives. Review patient medication lists and coordinate with providers for necessary prescription changes to avoid coverage denials.