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:
- Lecanemab (Leqembi) – Commercial only
- Mirvetuximab soravtansine-gynx (Elahere)
- Teclistamab-cqyv (Tecvayli)
- Tremelimumab (Imjudo)
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.
The following medical drug policies were revised:
- Belantamab mafodotin (Blenrep)
- Belatacept (Nulojix)
- Cerliponase Alfa (Brineura) – Commercial only
- Chimeric Antigen Receptor Therapy for Leukemia and Lymphoma
- Emicizumab-kxwh (Hemlibra) – Commercial only
- Esketamine (Spravato)
- Evinacumab-dgnb (Evkeeza) – Commercial only
- Immune Prophylaxis for Respiratory Syncytial Virus (RSV) – Commercial only
- Onasemnogene abeparvovec-xioi (Zolgensma) – Commercial only
- Oncologic Indications for Histone Deacetylase (HDAC) Inhibitors
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Rituximab (Rituxan), Rituximab Biosimilars, and Rituximab and Hyaluronidase Human (Rituxan Hycela)
- Therapeutic Radiopharmaceuticals in Oncology
The following medical drug policies had a coding change effective 1/1/2023:
The following medical drug policies were reviewed with no clinical content change:
- Alpha1-Proteinase Inhibitors
- Autologous Cellular Immunotherapy for Prostate Cancer
- Bendamustine (Treanda, Bendeka, Belrapzo)
- Emapalumab-lzsg (Gamifant) – Commercial only
- Eptinezumab-jjmr (Vyepti) – Commercial only
- Givosiran (Givlaari) – Commercial only
- Implantable Hormone Replacement Pellets
- Lurbinectedin (Zepzelca)
- Luspatercept (Reblozyl) – Commercial only
- Teprotumumab-trbw (Tepezza) – Commercial only
The following new retail pharmacy Utilization Management programs are effective 4/1/2023:
- Hyftor (sirolimus) Prior Authorization with Quantity Limit – NetResults only
- Relyvrio (sodium phenylbutyrate/taurursodiol) Prior Authorization with Quantity Limit
The following medical drug policies are revised 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.