ExchangeCoverageMedium impact
BCBSRI pharmacy program individual market formulary update July 1, 2021
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +4 more·Provider Update
Effective date
Jul 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI updated their individual market formulary effective July 1, 2021, excluding multiple drugs from coverage, requiring higher cost shares for some medications, and adding prior authorization requirements for Sucraid. Generic alternatives will be covered for excluded brand name drugs where available.
Action Required
By July 1, 2021: Billing team must update prior authorization workflows to require pre-approval for Sucraid prescriptions for BCBSRI individual market patients. Update patient counseling protocols to inform patients about excluded drugs (including Amantadine, Imipramine, Proair Respiclick, and others listed) and recommend generic alternatives where available. Update cost-sharing information for Flurbiprofen, Pyrazinamide, Hydrocortisone Butyrate, and Tyblume.