Medical Coverage Policy Prior Authorization of Drugs
Defines that certain prescription drugs for Blue Cross & Blue Shield of Rhode Island Medicare Advantage and Commercial medical plans require prior authorization through the plan's drug management vendor; provides contact and submission channels and notes exceptions (emergency, observation, inpatient).
No material clinical/coverage changes.
Policy overview
This policy centralizes prior authorization for drugs requiring authorization under Blue Cross & Blue Shield of Rhode Island (BCBSRI) Medicare Advantage and Commercial medical plans. Prior authorization is required for drugs listed in this policy when provided to members under Medicare Advantage Plans and Commercial Products. Clinical guidelines for approval and the vendor's drug listings are maintained by the plan's Drug Management vendor, Prime Therapeutics (via CoverMyMeds). Providers must submit prior authorization requests to the Drug Management vendor using the online portal at www.covermymeds.com, by fax to 1-855-212-8110, or by contacting Prime Therapeutics at 1-844-765-2892.