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 prior authorization policies are revised and effective Aug. 1, 2025:
- Certolizumab (Cimzia)
- Guselkumab (Tremfya)
- Mirikizumab-mrkz (Omvoh) IV
- Monoclonal Antibodies for the Treatment of Eosinophilic Conditions
- Natalizumab
- Risankizumab-rzaa (Skyrizi) IV
- Tildrakizumab-asmn (Ilumya)
- Tocilizumab
- Treatment of Hereditary Amyloidosis
- Ustekinumab IV
- Vedolizumab (Entyvio)
Commercial Updates
The following Commercial medical drug policies are new and effective Sept. 1, 2025:
*See www.gatewaypa.com/policydisplay/52 on or after Sept.1, 2025
- Starjemza IV (ustekinumab-hmny)
- Zusduri (mitomycin)
The following Commercial prior authorization medical drug policies have revisions effective Aug. 29, 2025:
*See www.gatewaypa.com/policydisplay/52
- Aflibercept
- Bavencio
- Casgevy
- Crysvita
- Evenity
- Imfinzi
- Imjudo
- Jemperli
- Keytruda
- Krystexxa
- Levoleucovorin
- Libtayo
- Loqtorzi
- Lyfgenia
- Onpattro
- Opdivo
- Opdualag
- Palonosetron
- Qalsody
- Radicava IV
- Sustol
- Tecentriq IV
- Tevimbra
- Tocilizumab IV
- Trastuzumab IV
- Unloxcyt
- Ustekinumab
- Vabysmo
- Vyjuvek
- Yervoy
The following Commercial post service claim edit medical drug policies have revisions effective Aug. 1, 2025:
*See www.gatewaypa.com/policydisplay/52
- Firmagon
- Leuprolide depot
- Supprelin LA
- Trelstar
- Triptodur
- Zoladex
- Zoledronic Acid
The following retail pharmacy Utilization Management programs are new:
- Alhemo Prior Authorization Program
- Effective Oct.1, 2025, for NetResults, Commercial and Health Insurance Marketplace Formularies
- Elmiron Prior Authorization with Quantity Limit Program
- Effective Oct. 1, 2025, adding quantity limit portion of the program for NetResults
- Prior authorization already active for NetResults Formulary
- Prior authorization with Quantity Limit already active for Commercial and Health Insurance Marketplace Formularies
- Journavx Quantity Limit Program
- Effective Oct. 1, 2025, for NetResults Formulary
- Phosphate Binder Quantity Limit Program
- Effective Oct. 1, 2025, for NetResults Formulary
- Sensipar Prior Authorization
- Effective Oct. 1, 2025, for NetResults
- Already active for Commercial and Health Insurance Marketplace Formularies
- Urinary Incontinence Quantity Limit Program
- Effective Oct. 1, 2025, for NetResults Formulary
- Vanrafia Prior Authorization with Quantity Limit Program
- Effective Oct. 1, 2025, for NetResults, Commercial and Health Insurance Marketplace Formularies
