BCBSRI is committed to providing our members with access to high-quality health care that is consistent with evidence-based, nationally recognized clinical criteria and guidelines. Therefore, we will be implementing a change in the way we manage certain specialty drugs that fall under the medical benefit. This new program will be administered by the Medical Pharmacy Solutions team at Prime Therapeutics (Prime).

Beginning April 24, 2026, providers should begin contacting Prime to obtain prior authorizations for the in-scope drugs for our members with dates of service on or after May 1, 2026.

For providers currently requesting medical benefit drug reviews with the Prime Pharmacy Benefit Team via CoverMyMeds and/or fax, this will represent a change in workflow. Providers will begin submitting medical benefit drug reviews for the in-scope drugs to Prime’s Medical Pharmacy Solutions team by navigating to GatewayPA.com, or via phone at 1-833-895-8282. Drugs that are typically self-administered by the patient will continue to be requested through CoverMyMeds and/or fax. 

The Medical Pharmacy Solutions team at Prime will be hosting two web-based training sessions in April. Please watch your email and our provider update and alert and update sections of our provider portal for updates and links for the upcoming webinars. The webinars are scheduled for: 

Monday, April 13, 2026 at 9:00 a.m. Click here to register

Monday, April 20, 2026 at 12:00 p.m. Click here to register

We appreciate your support in ensuring that our members continue receiving high-quality and clinically appropriate care. A list of the drugs that will be needed to enter into the new platform/site will be listed in our Pharmacy Post Claim Review Medications Payment Policy