Medical Pharmacy Solutions team at Prime Therapeutics

Blue Cross Blue Shield of North Dakota’s (BCBSND) commerical plan is committed to providing our members with access to high-quality health care consistent with evidence-based, nationally recognized clinical criteria and guidelines. Therefore, we will be implementing a change in the way we manage certain clinician administered drugs that fall under the medical benefit. This new process will be administered by the Medical Pharmacy Solutions team at Prime Therapeutics Management (Prime).

Beginning December 2, 2024, prescribers should begin contacting the Medical Pharmacy Solutions team at Prime to obtain prior authorizations (also known as precertifications or prior approvals) for the in-scope clinician administered drugs for our members with dates of service on or after Monday, December 9, 2024.

You can complete the prior authorization process via the online portal or phone. Prior authorization will be required for the clinician administered drugs when they are administered in the following settings:

Physician Office (POS 11)
Patient Homes (POS 12)
Outpatient Facilities (POS 19, 22)
CAR-T and Gene Cell Therapy (POS 21)

Prime will be hosting web-based training sessions in November 2024.

We appreciate your support to ensure our members continue receiving high-quality and clinically appropriate care. If you have questions, please contact the BCBSND Prescriber Service line at 1-800-368-2312.

Visit https://www.bcbsnd.com/providers/news-resources/healthcare-news/coming-soon-medical-pharmacy-prior-authorization-process-changes to learn more.