Medicare AdvantagePrior AuthHigh impact
Medicare Medical drug review effective July 1, 2020
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jul 1, 2020
We identified it
Jun 19, 2026
Summary
BCBSRI is expanding prior authorization requirements for drugs covered under the medical benefit for Medicare Advantage plans, with Prime Therapeutics handling all prior auth requests starting July 1, 2020. Providers can submit prior authorizations through electronic (CoverMyMeds), fax, phone, or mail options.
Action Required
By July 1, 2020: Billing team must establish CoverMyMeds account at www.covermymeds.com for electronic prior authorization submissions. Update workflow to obtain prior authorization for expanded list of medical benefit drugs before administering to BCBSRI Medicare Advantage patients. Contact Prime Therapeutics at 1-800-693-6651 for prior auth requests or status checks. Do not submit new authorization requests if active authorization exists until close to expiration. Claims for covered drugs without prior authorization will likely be denied.