CommercialPrior AuthMedium impact
Drug therapy review timeframes
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI updated drug therapy review timeframes and processes, emphasizing the need for complete clinical information at submission and timely responses to requests for additional information. Cases will be denied if essential information is not provided within specified timeframes, and late submissions will be treated as appeals.
Action Required
Immediately: All staff submitting drug therapy reviews must ensure complete clinical information is provided at initial submission. Set up CoverMyMeds accounts at www.covermymeds.com for electronic prior authorization submissions. Train staff to respond promptly when Prime Therapeutics requests additional information to avoid denials. Review all prior authorization forms before submission to ensure accuracy and completeness.