CommercialPrior AuthHigh impact
MDR Changes effective 7/01/2021
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Hematology, Ophthalmology +3 more·Physician / Facility
Effective date
Jul 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI is making significant Medical Drug Review (MDR) changes effective July and August 2021. Five drugs are being added to prior authorization requirements (effective 8/1/2021), nine drugs are having prior authorization removed, and 14 drugs are getting updated step therapy requirements where patients must try and fail specific alternative medications first.
Action Required
By July 1, 2021: Update billing system to reflect new step therapy requirements for eye injection drugs (Eylea, Lucentis, Beovu) and cancer support medications (Nyvepria, Fulphila, Ziextenzo) - patients must try Avastin/Mvasi/Zirabev or Neulasta/Udenyca first. By August 1, 2021: Add prior authorization requirements for iron infusions (Feraheme, Injectafer, Monoferric), hormone therapy (Histrelin, triptorelin), and update step therapy for biosimilar medications. Remove prior authorization from nine medications including Granix, Zarxio, Neulasta, and several cancer biosimilars. Contact Prime Therapeutics for all prior authorization requests. Claims will be denied without proper prior authorization or step therapy documentation.