Pharmacy & Specialty Drugs policy updates
Track new and updated Pharmacy & Specialty Drugs policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Prior Authorization of Drugs | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| Medical Pharmacy Program — Prior Authorization for Specialty Medications | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | May 1, 2026 |
| Medical Coverage Policy — Drugs Requiring Prior Authorization | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 5, 2026 |
| Medical-benefit prior authorization for specified drugs (MDR Drug Listing) | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2020 |
| Anticancer Medication — Orally Administered Anticancer Medication Cost-Sharing Parity | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2014 |
| off_label_drug_use_policy | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 12, 1994 |
| Prescriber Fax Form — Drug Prior Authorization Coverage Criteria | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | — |
| Prescription Drug and Pharmacy Benefit Coverage Criteria | Blue Cross Blue Shield - Rhode Island | Clinical | Pharmacy & Specialty Drugs | Modified | — |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.