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 polies effective date is September 2022, unless noted and policies will be undated within the next 30 days.
The following medical drug policies are new:
- Intravitreal Injections
- Risankizumab-rzaa (Skyrizi) IV – Commercial Only
The following medical drug policy will require precertification starting 9/1/2022:
- Bezlotoxumab (Zinplava) – Commercial Only; ME already requires precertification
The following medical drug policies were revised:
- Burosumab (Crysvita) – Commercial Only
- Carfilzomib (Kyprolis)
- Chemodenervation with Botulinum Toxin
- Edaravone (Radicava) – Commercial Only
- Efgartigimod (Vyvgart)
- Granulocyte Colony-Stimulating Factors
- Intra-Articular Hyaluronan Injections for Osteoarthritis of the Knee
- Onasemnogene abeparvovec-xioi (Zolgensma) – Commercial Only
- Plerixafor (Mozobil)
- Rituximab (Rituxan), Rituximab Biosimilars, and Rituximab and Hyaluronidase Human (Rituxan Hycela)
- Trilaciclib (Cosela)
The following medical drug policies had a coding change effective 7/1/2022:
- Chimeric Antigen Receptor Therapy for Multiple Myeloma
- Continuous Glucose Monitoring Systems – Commercial Only
- Immune Globulin Therapy
- Inclisiran (Leqvio)
- Sutimlimab-jome (Enjaymo)
- Tebentafusp-tebn (Kimmtrak)
- Tezepelumab-ekko (Tezspire)
The following medical drug policies were reviewed with no clinical content change:
- Lumasiran (Oxlumo) – Commercial Only
- Naxitamab (Danyelza)
- Panitumumab (Vectibix)
- Pertuzumab (Perjeta)
- Pralatrexate (Folotyn)
- Sacituzumab govitecan-hziy (Trodelvy)
The following new retail pharmacy Utilization Management program is effective 9/1/2022:
- IL-13 Antagonist Prior Authorization with Quantity Limit - Adbry (tralokinumab-ldrm)
The following new retail pharmacy Utilization Management programs are effective 10/1/2022:
- Cibinqo (abrocitinib) Prior Authorization with Quantity Limit
- Radicava (edaravone) Prior Authorization with Quantity Limit – oral solution
The following medical drug policies will be retired 8/31/2022:
