Blue Cross Blue Shield of North Dakota (BCBSND) is informing providers of an important benefit change for Omnipod products. Effective June 1, 2022, Omnipod 5 products will now be covered under pharmacy benefits. For members wanting to receive Omnipod 5 products at their pharmacy on or after June 1, 2022, providers will need to send a new prescription to the in-network retail pharmacy of choice and a new BCBSND medical precertification request.
Omnipod DASH and Omnipod 5 products must go through a BCBSND medical precertification process before they are covered on the pharmacy benefit. Providers should submit a new precertification (prior authorization) directly to BCBSND through the BCBSND medical precertification process, which can be done through Availity or by using the precertification information on our website. The provider should indicate on the precertification request that the member will be receiving the Omnipod DASH or Omnipod 5 through the pharmacy benefit (or the Omnipod Classic product (formerly Eros) through the medical benefit). Precertification requests should not be sent to Prime Therapeutics or through Cover My Meds. Omnipod products are not covered by BCBSND Medicaid Expansion.
For additional questions, call the BCBSND Customer Contact Center at 1-800-368-2312.