CommercialCoverageHigh impact
Commercial formulary update – October 1, 2019
Blue Cross Blue Shield of Rhode Island·RI · Gastroenterology, Rheumatology, Oncology +1 more·Provider Update
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Effective October 1, 2019, select products including all forms of Infliximab, Entyvio, and Immune Globulin have transitioned from pharmacy coverage to medical coverage for BCBSRI commercial plans. These products no longer require distribution through the specialty pharmacy network, though that option remains available.
Action Required
By October 1, 2019: Billing team must update procedures to bill Infliximab, Entyvio, and Immune Globulin products under medical coverage instead of pharmacy benefits for BCBSRI commercial members. Update billing system settings and inform providers that specialty pharmacy distribution is now optional, not required. Verify coverage source before submitting claims to avoid denials.