Blue Cross Blue Shield of North Dakota (BCBSND) continually develops and revises pharmacy policies in response to rapidly changing pharmaceutical requirements. Our commitment is to update the provider community as pharmacy policies are adopted and/or revised.
Medicaid Expansion Updates
Note: There may be corresponding policies for our Commercial lines of business.
The following Medicaid Expansion medical drug policies are new and effective April 1, 2025:
- Afamitresgene autoleucel (Tecelra)
- Axatilimab-csfr (Niktimvo)
- Eladocagene exuparvovec-tneq (Kebilidi)
- Zanidatamab (Ziihera)
- Zolbetuximab-clzb (Vyloy)
The following Medicaid Expansion medical drug policies are revised and effective April 1, 2025:
- Agalsidase beta (Fabrazyme) & Pegunigalsidase alfa-iwxj (Elfabrio)
- Burosumab (Crysvita)
- Cerliponase Alfa (Brineura)
- Eptinezumab-jjmr (Vyepti)
- Givosiran (Givlaari)
- Glofitamab-gxbm (Columvi)
- Mirikizumab-mrkz (Omvoh) IV
- Natalizumab
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Sacituzumab govitecan-hziy (Trodelvy)
- Teprotumumab-trbw (Tepezza)
- Treatment of Gaucher Disease
- Ustekinumab IV
The following Medicaid Expansion medical drug policies are revised and effective May 1, 2025:
- Elosulfase alfa (Vimizim)
- Esketamine (Spravato)
- Guselkumab (Tremfya)
- Idursulfase (Elaprase)
- Laronidase (Aldurazyme)
- Risankizumab-rzaa (Skyrizi) IV
- Sebelipase alfa (Kanuma)
- Tildrakizumab-asmn (Ilumya)
- Vedolizumab (Entyvio)
- Velmanase alfa-tycv (Lamzede)
- Vestronidase Alfa-vjbk (Mepsevii)
The following Medicaid Expansion medical drug policies have a coding change effective April 1, 2025:
- Denileukin diftitox-cxdl (Lymphir)
- Eculizumab and Ravulizumab
- Granulocyte Colony-Stimulating Factors
- Intravitreal Injections
- Ocrelizumab (Ocrevus)
- Ustekinumab IV
The following Medicaid Expansion medical drug policies were reviewed with no clinical content change:
- Alglucosidase alfa (Lumizyme) and Avalglucosidase alfa-ngpt (Nexviazyme)
- Pertuzumab (Perjeta)
- Pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo)
- Trabectedin (Yondelis)
- Vyondys 53 (golodirsen)
Medicaid Expansion/Commercial Updates
The following Medicaid Expansion and Commercial medical drug policy was reviewed with no clinical content change:
- Implantable Hormone Replacement Pellets
Commercial Updates
The following Commercial medical drug policy is revised and effective April 1, 2025:
- Contraceptive Management
The following Commercial medical drug policy is new and effective March 1, 2025:
*Refer to: www.gatewaypa.com/policydisplay/52 on or after March 1, 2025
- Datroway
The following Commercial prior authorization medical drug policies have revisions effective April 4, 2025:
*see www.gatewaypa.com/policydisplay/52
- Adcetris
- Adstiladrin
- Anktiva
- Bendamustine
- Casgevy
- Darzalex IV
- Denosumab
- Erbitux
- Ilaris
- Jelmyto
- Lyfgenia
- Nplate
- Omvoh
- Onivyde
- Oxlumo
- Padcev
- Rituximab IV
- Skysona
- Tecentriq
- Tevimbra
- Ustekinumab
- Vectibix
The following Commercial prior authorization medical drug policies have revisions effective April 29, 2025:
*Refer to: www.gatewaypa.com/policydisplay/52
- Bevacizumab oncology
- Cabazitaxel
- Cimzia
- Cosentyx
- Denosumab (effective May 1, 2024)
- Elevidys
- Enhertu
- Entyvio IV
- Gamifant
- Ilumya
- Infliximab
- Izervay
- Leqembi
- Lymphir
- Orencia
- Paclitaxel Albumin-Bound
- Pemetrexed
- Provenge
- Rystiggo
- Simponi Aria
- Skyrizi IV
- Spevigo IV
- Susvimo
- Sylvant
- Tocilizumab IV
- Trastuzumab IV
- Tremfya
- Ustekinumab
- Vabysmo
- Vyvgart IV
- Yervoy
The following Commercial post service claim edit medical drug policies have revisions:
*Refer to: www.gatewaypa.com/policydisplay/52
- Aranesp (effective March 1, 2025)
- Bortezomib (effective April 1, 2025)
- Epoetin alfa (effective March 1, 2025)
- Mircera (effective March 1, 2025)
- PAH IV-SC (effective April 1, 2025)
The following Commercial Post Service Claim Edit medical drug policy will be retired on Feb. 1, 2025:
- Ondansetron
The following retail pharmacy Utilization Management programs are new:
- Hympavzi Prior Authorization with Quantity Limit
- Effective July 1, 2025, for NetResults, Commercial and Health Insurance Marketplace Formularies
- Niemann-Pick Disease Type C Agents (Aqneursa, Miplyffa) Prior Authorization with Quantity Limit
- Effective May 1, 2025, for NetResults, Commercial and Health Insurance Marketplace Formularies
- Phosphate Binder Step Therapy with Quantity Limit Program
- Effective July 1, 2025, for Health Insurance Marketplace Formulary
- Yorvipath Prior Authorization with Quantity Limit
- Effective May 1, 2025, for NetResults, Commercial and Health Insurance Marketplace Formularies
