All PlansCoverageMedium impact
Update for pharmacy coverage - PCSK-9s
Blue Cross Blue Shield of Rhode Island·RI · Cardiology, Internal Medicine, Family Medicine +1 more·Physician
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
PCSK-9 cholesterol medications (Repatha and Praluent) are now available through both retail and specialty pharmacies with lower non-preferred brand formulary tier designation, effective July 1, 2019. The medications are no longer restricted to specialty pharmacy networks only, but all existing utilization management programs remain in place.
Action Required
Billing team should verify pharmacy network options when processing claims for PCSK-9 medications (Repatha and Praluent). Update patient education materials to inform them these medications are now available at retail pharmacies. Continue following existing prior authorization and utilization management requirements as no changes were made to coverage eligibility processes.