Provider Remittance Advices
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1 de mayo de 2020

Medicare Medical drug review effective 1 de julio de 2020

As part of our ongoing efforts to make high-quality and affordable healthcare available to our members, BCBSRI regularly reviews the list of prescription drugs we cover under our medical benefit. Our goal is to make sure that our members continue to have access to effective medications at the lowest possible cost.

As a result, effective 1 de julio de 2020, BCBSRI will begin requiring prior authorization for an expanded list of drugs that are covered under the medical benefit for our Medicare Advantage products (e.g., BlueCHiP for Medicare and HealthMate for Medicare). Prior authorization review will be handled by our pharmacy benefits manager Prime Therapeutics, LLC, who will begin processing requests for prior authorization on 1 de julio de 2020.

Medicare Advantage members currently receiving these medications will be notified of this upcoming change. We are recommending that our members affected by these changes discuss their medication treatment options with their provider to determine whether their medications are still right for them.

If your office has an active authorization, please refrain from entering a new authorization request until the active authorization is close to expiring.

You may obtain prior authorization through one of the following methods:

  • Electronic prior authorization (ePA)CoverMyMeds is the ePA tool offered through BCBSRI and Prime Therapeutics. Using CoverMyMeds allows for electronic submission of prior authorizations for any prescription drug. When you submit prior authorizations electronically, they are seamlessly integrated with your electronic health record system, offering you ePA functionality right in your office. Some of the benefits include:
    • Reduction of administrative waste
    • Faster determinations
    • Validated and accurate prior authorization requests
       
      To create a CoverMyMeds account:
    • Go to www.covermymeds.com.
    • Click on “Create a Free Account."
    • Log in using the email and password you registered with.
       
  • Prior authorization by fax
    You can fax the prior authorization form to 1-855-212-8110.
  • Prior authorization by phone

      Call 1-800-693-6651.

  • Prior authorization by mail
    Send your PA form to:
    Part B Benefit requests
    2900 Ames Crossing Road
    Eagan, MN 55121
     
    Prior Authorization forms for drugs under both the medical benefit and pharmacy benefit are located in the Pharmacy Information section of the provider portal at myprime.com. Additionally, the Prior Authorization of Drugs policy will be available on bcbsri.com no later than 1 de mayo de 2020.
     
    For assistance with prior authorizations or for a status on existing prior authorizations, please call Prime Therapeutics at 1-800-693-6651.
     
    Prime Therapeutics will begin to accept prior authorization requests for dates of service 1 de julio de 2020 and after as of 1 de julio de 2020. Prime Therapeutics cannot accept requests prior to 1 de julio de 2020. Any authorizations for dates of service prior to 1 de julio de 2020 will follow the current process.
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