BCBSRI Is committed to ensuring our members and providers have access to the right care for their health needs.  BCBSRI recognizes there Is a stimulant shortage In RI and throughout the US that Is creating difficulties for our members and providers.  BCBSRI has maintained a generous policy of coverage for many years for stimulants and the limitations are generally regulation limitations. BCBSRI has taken steps to ensure providers and members are aware of their options and to decrease barriers to obtaining needed medications. 

Actions Implemented by BCBSRI regarding the ADHD Stimulant (CII) Shortage

• Pharmacy Network notice via email was distributed as a reminder that we cover all brand and generic versions of the most common products.
• All BCBSRI formularies include coverage of both the brand name and the generic equivalent versions of Adderall, Adderall XR, Concerta, Daytrana, Focalin, Focalin XR and the Ritalin product lines. They have no prior auth requirements, only copay tier differences.
• We are suggesting to members to ask the pharmacy if they have the brand name in stock as an alternative if the generic is unavailable.
• BCBSRI does not have utilization management programs applied to these medications, no step therapy, no prior authorizations.
• In February 2023, BCBSRI removed all quantity limits for these medications to facilitate and allow for higher quantities of inventory available.
• Our website supports a pricing tool through Prime to provide an estimated cost for a prescription.

https://www.bcbsri.com/individual/member/pharmacycoverage

RI Rules and Regulations that may Impact the ADHD Stimulant (CII) Shortage

• Current quantity limits 30 days’ supply.
• Prescription Is not valid after 90 days from the date written.
• Prescription does not allow refills.
• No fax allowed as original prescription (exception: LTCF, Hospice, Infusion Centers); must be signed and transmitted electronically by provider; therefore, no transfers of prescriptions between different pharmacies.
• If patient requests a partial fill; the balance cannot be filled later; the balance Is void.
• Use the correct dispense as written (DAW) codes to process prescriptions when substituting brand to generic versions/formulations and vice versa.