Medicaid Expansion Pharmacy Policy Updates

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.

Medical Pharmacy

The following Medicaid Expansion medical drug prior authorization policy is new and effective April 1, 2026:

• Onasemnogene abeparvovec-brve (Itvisma)

The following Medicaid Expansion prior authorization medical drug policies have revisions effective April 1, 2026:

• Afamitresgene autoleucel (Tecelra) 
• Alemtuzumab (Lemtrada) 
• Burosumab (Crysvita) 
• Eptinezumab-jjmr (Vyepti) 
• Glofitamab-gxbm (Columvi) 
• Granulocyte Colony-Stimulating Factors
  • Added new drug pegfilgrastim-cbve (Armlupeg) 
• Idursulfase (Elaprase) 
• Monoclonal Antibodies for the Treatment of Eosinophilic Conditions 
  • Added new drug Exdensur
• Natalizumab 
• Ocrelizumab (Ocrevus) 
  • Updated Ocrevus Zunovo to non-preferred agent 
• Pertuzumab (Perjeta) 
• Pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo) 
• Sacituzumab govitecan-hziy (Trodelvy) 
• Teprotumumab-trbw (Tepezza) 
• Velmanase alfa-tycv (Lamzede) 
• Vestronidase Alfa-vjbk (Mepsevii)                 

The following Medicaid Expansion medical drug policies were reviewed and have no changes:

• Agalsidase beta (Fabrazyme) & Pegunigalsidase alfa-iwxj (Elfabrio) 
• Axatilimab-csfr (Niktimvo) 
• Cerliponase Alfa (Brineura)          
• Denileukin diftitox-cxdl (Lymphir) 
• Eladocagene exuparvovec-tneq (Kebilidi) 
• Givosiran (Givlaari) 
• Laronidase (Aldurazyme) 
• Sebelipase alfa (Kanuma) 
• Vyondys 53 (golodirsen)