Blue Cross Blue Shield of North Dakota (BCBSND) regularly 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.
The following medical drug policies are new:
The following medical drug policies are new and specific for Medicaid Expansion:
Note: There may be corresponding policies for our Commercial lines of business or policies that apply to both Commercial and Medicaid Expansion lines of business.
- Capsaicin patch (Qutenza)
- Efgartigimod (Vyvgart)
- Inclisiran (Leqvio)
- Plasminogen, human-tvmh (Ryplazim)
- Sutimlimab-jome (Enjaymo)
- Tezepelumab-ekko (Tezspire)
The following medical drug policies were revised:
- Alemtuzumab (Lemtrada) – Commercial only
- Amivantamab-vmjw (Rybrevant)
- Brentuximab Vedotin (Adcetris)
- Brexanolone (Zulresso)
- Chemodenervation with Botulinum Toxin
- Crizanlizumab-tmca (Adakveo)
- Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro)
- Emicizumab-kxwh (Hemlibra) – Commercial only
- Fam-trastuzumab Deruxtecan-nxki (Enhertu)
- Gonadotropin Releasing Hormones (GnRHs) Analogs
- Granulocyte Colony-Stimulating Factors
- Human Growth Hormone – Commercial only
- Intravitreal Implants
- Medications and Diabetic Supplies Payable on the Pharmacy Benefit – Medicaid Expansion only
- Pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo)
- Pharmacologic Treatment of Pulmonary Arterial Hypertension
- Polatuzumab vedotin-piiq (Polivy)
- Portable External Infusion Pump – Commercial only
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Rituximab (Rituxan), Rituximab Biosimilars, and Rituximab and Hyaluronidase Human (Rituxan Hycela)
- Trabectedin (Yondelis)
- Trastuzumab (Herceptin), Trastuzumab Biosimilars, and Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
- Treatment of Hereditary Amyloidosis – Commercial only
The following medical drug policies had a coding change effective 10/1/2022:
- Bevacizumab (Avastin) and Bevacizumab Biosimilars
- Chimeric Antigen Receptor Therapy for Multiple Myeloma
- Contraceptive Management – Commercial only
- Eculizumab (Soliris) and Ravulizumab (Ultomiris)
- Immune Prophylaxis for Respiratory Syncytial Virus (RSV) – Commercial only
- Intravitreal Injections
- Sutimlimab-jome (Enjaymo)
- Tebentafusp-tebn (Kimmtrak)
The following medical drug policies were reviewed with no clinical content change:
- Ado-trastuzumab emtansine (Kadcyla)
- Belatacept (Nulojix)
- Blinatumomab (Blincyto)
- Casimersen (Amondys-45) – Commercial only
- Certolizumab (Cimzia) – Commercial only
- Continuation of Drug Therapy
- Evinacumab-dgnb (Evkeeza) – Commercial only
- Isatuximab-irfc (Sarclisa)
- Melphalan Flufenamide (Pepaxto)
- Oncologic Indications for Histone Deacetylase (HDAC) Inhibitors
- Tocilizumab (Actemra) – Commercial only
- Treatment of Gaucher Disease – Commercial only
- Ziv-aflibercept (Zaltrap)
The following new retail pharmacy Utilization Management programs are effective 10/1/2022:
- Ergotamine Step Therapy Quantity Limit (Cafergot, D.H.E., Erogmar, Ergotamine/Caffeine, Migergot) – NetResults Formulary only
- Recorlev Prior Approval Quantity Limit (PAQL)
- Tarpeyo PAQL
The following Medicaid Expansion medical drug policies will be retired 10/31/2022:
- Immune Prophylaxis for Respiratory Syncytial Virus (RSV) – Medicaid Expansion only
- Onasemnogene abeparvovec (Zolgensma) – Medicaid Expansion only