CommercialCoverageHigh impact
Drugs moving from the specialty pharmacy benefit to the medical benefit 4/1/21
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Rheumatology, Ophthalmology +3 more·Physician
Effective date
Apr 1, 2021
We identified it
Jun 19, 2026
Summary
Effective April 1, 2021, BCBSRI moved 15 specialty drugs from the specialty pharmacy benefit to the medical benefit, making them eligible for buy-and-bill with specific HCPCS codes. These drugs no longer need to be obtained from AllianceRx/Walgreens Specialty Pharmacy and can be billed directly by providers using the designated HCPCS codes.
Action Required
By April 1, 2021: Billing team must update system to bill these 15 specialty drugs using the specific HCPCS codes provided (J3262, J0585, J0586, etc.) instead of routing through specialty pharmacy. Update encounter forms with new HCPCS codes for buy-and-bill procedures. Add administration codes as previously utilized. Verify prior authorization status through CoverMyMeds, fax, or mail for drugs requiring MDR program approval.