Hemophilia Drug Benefit Change for Commercial Members*

Blue Cross Blue Shield of North Dakota (BCBSND) is informing providers of an important benefit change for hemophilia drug products for Commercial Members.  Effective January 1, 2023, the below list of hemophilia drug products will now be covered under pharmacy benefits and will require prior authorization. These products will no longer be eligible for coverage under the medical benefit. For members wanting to receive one of the below hemophilia drug products at their pharmacy on or after January 1, 2023, providers will need to send a new prescription to an in-network specialty pharmacy of choice and a prior authorization request with required documentation to Prime Therapeutics.

Factor IX Products

Factor VIII and
von Willebrand Factor Products

Factor VIIa Products

Hemophilia Monoclonal Antibody Products

Human Fibrinogen Concentrate Products

Factor X Products

AlphaNine SD® - J7193

Advate® - J7192

NovoSeven RT® - J7189

Hemlibra® - J7170

Fibryga® - J7177

Coagadex® - J7175

Alprolix® - J7201

Adynovate® - J7207

Sevenfact® - J7212

RiaSTAP® - J7178

BeneFIX® - J7195

Afstyla® - J7210

Idelvion® - J7202

Alphanate® - J7186

Ixinity® - J7195

Eloctate® - J7205

Mononine® - J7193

Esperoct® - J7204

Profilnine® SD – J7194

Hemofil M® - J7190

Rebinyn® - J7203

Humate-P® - J7187

Rixubis® - J7200

Jivi® - J7208

Koāte®/Koāte-DVI® - J7190

Kogenate FS® - J7192

Kovaltry® - J7211

NovoEight® - J7182

Nuwiq® - J7209

Recombinate® - J7192

Vonvendi® - J7179

Wilate® - J7183

Xyntha®/Xyntha Solofuse® - J7185

*No change for Medicaid Expansion members as hemophilia drug products are currently a pharmacy benefit.

For additional questions, call the BCBSND Customer Contact Center at 1-800-368-2312.