Medicare AdvantagePrior AuthHigh impact
Medical Drug Review
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Hematology, Neurology +1 more·Physician / Facility
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island now requires prior authorization for 15 specific drugs effective between January 1 and February 1, 2025. Most drugs require authorization for both Medicare and Commercial plans, but 5 drugs (Bizengri, Ocrevus Zunovo, Tecelra, Tecentriq Hybreza, and Ziihera) require no prior authorization.
Action Required
By January 1, 2025: Billing team must update prior authorization requirements for 10 specific drugs (Alygo, Axtle, Bkemv, Fulphila, Hercessi, Nypozi, Pyzchiva, and Romiplostim) for both Medicare and Commercial patients. By February 1, 2025: Add prior authorization for Docivyx and Pemrydi RTU for both plan types. Ensure billing system flags these HCPCS/J-codes for authorization before claims submission. Claims without proper authorization will be denied.