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Feb 4, 2022

Changes being made to the Medical Drug Review (MDR) program

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, the following changes are being made to the Medical Drug Review (MDR) program. Existing and new prior authorization reviews will continue to be handled by our pharmacy benefits manager, Prime Therapeutics.

Code       Drug Name                                                         Prior Authorization               Step Therapy*                            Commercial Effective/Date of Change

J3032      Vepto                                                                           Add                              Aimovig, Emgality, Ajovy                  04/01/2022

J1950      Lupron Dept 3.75mg, 11.25mg                                    Add                             Zoladex, Trelstar                               04/01/2022

J1950      Lupron Dept 7.5mg, 11.25mg, 15mg, 30mg                Add                             Trelstar                                              04/01/2022

 

*Step therapy requires that specific drug(s) be used for treatment prior to another drug being allowed for coverage

Please note the following Gonadotropin Releasing Hormone (GnRH)  codes/drugs will continue to be covered WITHOUT requiring Prior Authorization:

J9217   Lupron Depot 7.5mg, 22.5mg, 30mg, 45mg

J9217   Eligard 7.5mg, 22.5mg, 30mg, 45mg

J3316   Trelstar 22.5mg

J9202   Zoladex 3.6mg, 10.8mg