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.
The following medical drug policies are new:
- Beremagene geperpavec-svdt (Vyjuvek)
- Delandistrogene moxeparvovec (Elevidys) – Commercial only
- Therapeutic Radiopharmaceuticals for Prostate Cancer
- Valoctocogene Roxaparvovec-rvox (Roctavian)
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.
- Etranacogene dezaparvovec (Hemgenix)
- Lecanemab (Leqembi)
- Olipudase alfa-rpcp (Xenpozyme)
- Teplizumab-mzwv (Tzield)
The following medical drug policies were revised and will require precertification effective October 1, 2023:
- Autologous Cellular Immunotherapy for Prostate Cancer
- Plerixafor (Mozobil)
The following medical drug policy had a title change:
- Therapeutic Radiopharmaceuticals for Neuroendocrine Tumors (previous title: Therapeutic Radiopharmaceuticals in Oncology)
The following medical drug policies were revised:
- Alpha1-Proteinase Inhibitors
- Bezlotoxumab (Zinplava)
- Carfilzomib (Kyprolis)
- Chemodenervation with Botulinum Toxin
- Continuous Glucose Monitoring Systems – Commercial only
- Efgartigmod alfa-fcab (Vyvgart) and Efgartigmod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo) – Commercial only (revision includes addition of Vyvgart Hytrulo)
- Granulocyte Colony-Stimulating Factors – Commercial only
- Immune Globulin Therapy
- Inclisiran (Leqvio) – Commercial only
- Mogamulizumab-kpkc (Poteligeo)
- Moxetumomab Pasudotox-tdfk (Lumoxiti)
- Pertuzumab (Perjeta)
- Tafasitamab-cxix (Monjuvi)
- Tagraxofusp-erzs (Elzonris)
- Tisotumab vedotin-tftv (Tivdak)
The following medical drug policies had a coding change effective July 1, 2023:
- Bendamustine (Treanda, Bendeka, Belrapzo)
- Hemophilia Products – Commercial only
- Immune Globulin Therapy
- Mirvetuximab soravtansine-gynx (Elahere)
- Mosunetuzumab-axgb (Lunsumio)
- Nadofaragene firadenovec-vncg (Adstiladrin)
- Teclistamab-cqyv (Tecvayli)
- Teplizumab-mzwv (Tzield)
- Tremelimumab (Imjudo)
- Ublituximab-xiiy (Briumvi) – Commercial only
The following medical drug policies were reviewed with no clinical content change:
- Burosumab (Crysvita) – Commercial only
- Edaravone (Radicava) – Commercial only
- Naxitamab (Danyelza)
- Sacituzumab govitecan-hziy (Trodelvy)
- Trilaciclib (Cosela)
The following new retail pharmacy Utilization Management programs are effective October 1, 2023:
- Daybue PAQL –NetResults Formulary only
- Filspari PAQL – All Formularies
- Rezurock PAQL – All Formularies
- Skyclarys PAQL – NetResults Formulary only
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.
- Aducanumab-avwa (Aduhelm)
- Medication Therapy Management Services (MTMS)
- Pegloticase (Krystexxa)
- Teprotumumab-trbw (Tepezza)
Questions?
If you have additional questions regarding pharmacy policy changes, please contact the appropriate Provider Service Center.
- BCBSND 1-800-368-2312
- Medicaid Expansion 1-833-777-5779
