All PlansCoverageMedium impact
Pharmacy medication update
Blue Cross Blue Shield of Rhode Island·RI · Neurology, Family Medicine, Internal Medicine +1 more·Physician
Effective date
Apr 1, 2019
We identified it
Jun 20, 2026
Summary
Effective April 1, 2019, Radicava (medication for ALS) will be covered under the medical benefit instead of the specialty pharmacy benefit. Additionally, numerous birth control medications have been removed from the ACA eligible list, affecting coverage for 1,371 members.
Action Required
By April 1, 2019: Billing team must update system to bill Radicava under medical benefit codes instead of pharmacy benefit codes. Update encounter forms and notify providers that Radicava should now be billed as a medical service rather than through specialty pharmacy. Review patient records for the listed birth control medications and verify coverage status before prescribing.