CommercialPrior AuthHigh impact
MDR Changes effective 8/01/2021
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Hematology, Nephrology +3 more·Physician / Facility
Effective date
Aug 1, 2021
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island updated their Medical Drug Review (MDR) program effective 8/1/2021, adding prior authorization requirements for 5 injectable drugs and removing prior auth for 9 drugs. Additionally, brand-name drugs now require documented trial and failure of specific biosimilar alternatives before approval.
Action Required
By August 1, 2021: Billing team must update prior authorization workflows to obtain approval for Feraheme (Q0138), Injectafer (J1439), Monoferric (J1437), Histrelin implant (J9226), and triptorelin (J3316) for Commercial plans. Remove prior auth requirements for Granix (J1447), Zarxio (Q5101), Kanjinti (Q5117), Trazimera (Q5116), Neulasta (J2505), Udenyca (Q5111), Mvasi (Q5107), and Zirabev (Q5118). Update billing system to require documentation of biosimilar trial and failure before using brand-name alternatives. Claims without proper prior authorization or documentation will be denied.