CommercialPrior AuthHigh impact
Commercial MDR Drugs requiring step-therapy 4/1/21
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Hematology·Physician / Facility
Effective date
Apr 1, 2021
We identified it
Jun 19, 2026
Summary
Effective April 1, 2021, BCBS Rhode Island requires step therapy through biosimilar medications before approving five specific commercial MDR drugs: Avastin, Herceptin, Rituxan, Neulasta, and Neupogen. Patients must try the biosimilar alternative first before the brand-name drug will be covered.
Action Required
Immediately: Update prior authorization protocols to require step therapy documentation for Avastin, Herceptin, Rituxan, Neulasta, and Neupogen. Billing team must verify biosimilar trial before submitting claims for these brand-name drugs. Providers should be notified to prescribe biosimilar alternatives first. Claims for brand-name versions without documented biosimilar failure will likely be denied.