NOTE** Review policies online to determine if the policy applies to both BCBSND Commercial and/or Medicaid Expansion Plans.
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. Listed are the policy updates for June and July 2022.
The following medical drug policies were revised:
- Bevacizumab (Avastin) and Bevacizumab Biosimilars
- Contraceptive Management – Commercial only
- Copanlisib (Aliqopa)
- Drug Indications
- Eculizumab (Soliris) and Ravulizumab (Ultomiris) – Commercial only
- Elotuzumab (Empliciti)
- Enfortumab vedotin-ejfv (Padcev)
- Enzyme Replacement Therapies – Commercial only
- Esketamine (Spravato)
- Fam-trastuzumab Deruxtecan-nxki (Enhertu)
- Immune Globulin Therapy
- Inebilizumab-cdon (Uplizna) – Commercial only
- Inhalation Products for the Management of Cystic Fibrosis
- Intra-Articular Hyaluronan Injections for Osteoarthritis of the Knee
- Intravenous Anesthetics for Off-Label Indications
- Irinotecan Liposomal (Onivyde)
- Margetuximab-cmkb (Margenza)
- Pegaspargase (Oncaspar), Asparaginase Erwinia Chrysanthemi (Erwinaze, Rylaze), and Calaspargase Pegol-mknl (Asparlas)
- Pegloticase (Krystexxa) – Commercial only
- Portable External Infusion Pump – Commercial only
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Ramucirumab (Cyramza)
- Rituximab (Rituxan), Rituximab Biosimilars, and Rituximab and Hyaluronidase Human (Rituxan Hycela)
- Siltuximab (Sylvant)
- Treatment of Hereditary Amyloidosis – Commercial only
The following medical drug policies were reviewed with no clinical content change:
- Bezlotoxumab (Zinplava)
- Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro)
- Edaravone (Radicava)
- Ofatumumab (Arzerra)
- Tagraxofusp-erzs (Elzonris)
- Viltolarsen (Viltepso)
The following new retail pharmacy Utilization Management program is effective 7/1/2022:
- Voxzogo PAQL – for NetResults Formulary only
The following medical drug policies were 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.
The following medical drug policies will be retired June 30, 2022:
- Agalsidase beta (Fabrazyme) – Commercial only
- Daunorubicin and Cytarabine Liposomal (Vyxeos)
- Elosulfase alfa (Vimizim) – Commercial only
- Galsulfase (Naglazyme) – Commercial only
- Idursulfase (Elaprase) – Commercial only
- Laronidase (Aldurazyme) – Commercial only
- Sebelipase alfa (Kanuma) – Commercial only
- Vestronidase Alfa-vjbk (Mepsevii) – Commercial only