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. All policies are applicable to Commercial and Medicaid Expansion unless otherwise noted.
The following medical drug policies are new:
- Mosunetuzumab-axgb (Lunsumio)
- Nadofaragene firadenovec-vncg (Adstiladrin)
- Teplizumab-mzwv (Tzield) – Commercial only
- Ublituximab-xiiy (Briumvi) – Commercial only
The following medical drug policy was revised and will require precertification as of 5/1/2023:
- Therapeutic Radiopharmaceuticals in Oncology
The following medical drug policies were revised:
- Ado-trastuzumab emtansine (Kadcyla)
- Alemtuzumab (Lemtrada) – Commercial only
- Anifrolumab-fnia (Saphnelo)
- Belimumab (Benlysta)
- Bendamustine (Treanda, Bendeka, Belrapzo)
- Capsaicin patch (Qutenza) – Commercial only
- Cetuximab (Erbitux)
- Denosumab (Prolia, Xgeva) – Commercial only
- Eptinezumab-jjmr (Vyepti) – Commercial only
- Givosiran (Givlaari) – Commercial only
- Granulocyte Colony-Stimulating Factors – Commercial only
- Human Growth Hormone- Commercial only
- Ibalizumab-uiyk (Trogarzo)
- Isatuximab-irfc (Sarclisa)
- Lecanemab (Leqembi) – Commercial only
- Luspatercept (Reblozyl) – Commercial only
- Natalizumab (Tysabri) – Commercial only
- Nusinersen (Spinraza) – Commercial only
- Ocrelizumab (Ocrevus) – Commercial only
- Repository Corticotropin Intramuscular Injection – Commercial only
- Romosozumab-aqqg (Evenity)
- Teprotumumab-trbw (Tepezza) – Commercial only
- Voretigene Neparvovec-rzyl (Luxturna) – Commercial only
The following medical drug policies had a coding change effective 4/1/2023:
- Bevacizumab (Avastin) and Bevacizumab Biosimilars
- Enzyme Replacement Therapies – Commercial only
- Etranacogene dezaparvovec-drlb (Hemgenix)
- Granulocyte Colony-Stimulating Factors
- Intravitreal Injections
- Mirvetuximab soravtansine-gynx (Elahere)
- Spesolimab (Spevigo)
- Teclistamab-cqyv (Tecvayli)
- Tremelimumab (Imjudo)
The following medical drug policies were reviewed with no clinical content change:
- Eribulin Mesylate (Halaven)
- Hydroxyprogesterone Caproate Injection as a Technique to Reduce Preterm Birth in High-Risk Pregnancies – Commercial only
- Injectable Collagenase Clostridium Histolyticum (Xiaflex)
- Loncastuximab tesirine-lpyl (Zynlonta)
- Moxetumomab Pasudotox-tdfk (Lumoxiti)
- Obinutuzumab (Gazyva)
- Tafasitamab-cxix (Monjuvi)
- Tisotumab vedotin-tftv (Tivdak)
- Viltolarsen (Viltepso) – Commercial only
- Vuity (pilocarpine hydrochloride ophthalmic solution) – Commercial only
- Vyondys 53 (Golodirsen) – Commercial only
The following retail pharmacy Utilization Management program was effective 3/1/2023:
- Korlym Prior Authorization with Quantity Limit
The following retail pharmacy Utilization Management program was effective 4/1/2023:
- Ampyra Prior Authorization with Quantity Limit
The following retail pharmacy Utilization Management programs have changes:
- GLP-1 Agonists Prior Authorization with Quantity Limit – Mounjaro added as a preferred agent (effective 4/1/2023)
- Growth Hormone Prior Authorization – Genotropin added as a preferred agent (effective 1/13/2023)
The following NetResults Formulary retail pharmacy Utilization Management programs will be retired:
- Lucemyra Prior Authorization with Quantity Limit
- Oral NSAID Step Therapy
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.
- Alglucosidase alfa (Lumizyme) and Avalglucosidase alfa-ngpt (Nexviazyme) – ME (Medicaid Expansion) only
- Granulocyte Colony-Stimulating Factors – ME only
- Vyondys 53 (golodirsen) – ME only
