CommercialPrior AuthHigh impact
Lifespan employee group – Specialty Drug change effective 05/01
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Rheumatology, Neurology +5 more·Physician / Facility
Effective date
May 1, 2020
We identified it
Jun 19, 2026
Summary
Effective May 1, 2020, Lifespan employee group members will have medical specialty drugs covered under their medical benefit instead of pharmacy benefit. All specialty drugs requiring prior authorization must now be submitted to Prime Therapeutics for review, including those administered in physician offices.
Action Required
Effective May 1, 2020: Billing team must submit all prior authorization requests for the listed specialty drugs to Prime Therapeutics instead of previous authorization processes. Update billing workflows to route specialty drug prior auths through Prime Therapeutics system, including drugs administered in physician offices which previously did not require Prime review. Failure to obtain proper authorization through Prime may result in claim denials.