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 policy is new:
The following medical drug policies were revised:
- Continuous Glucose Monitoring Systems
- Eculizumab (Soliris) and Ravulizumab (Ultomiris)
- Human Growth Hormone
- Ipilimumab (Yervoy)
- Ixabepilone (Ixempra)
- Mogamulizumab-kpkc (Poteligeo)
- Monoclonal Antibodies for the Treatment of Eosinophilic Conditions
- Omalizumab (Xolair)
- Pegcetacoplan (Empaveli)
- Pharmacologic Treatment of Pulmonary Arterial Hypertension
- Portable External Infusion Pump
- Repository Corticotropin Intramuscular Injection (Acthar Gel)
- Romiplostim (Nplate)
The following medical drug policies had coding changes effective 1/1/2022:
- Aducanumab-avwa (Aduhelm)
- Amivantamab-vmjw (Rybrevant)
- Anifrolumab-fnia (Saphnelo)
- Granulocyte Colony-Stimulating Factors
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
The following medical drug policies were reviewed with no clinical content change:
- Alpha1-Proteinase Inhibitors
- Autologous Cellular Immunotherapy for Prostate Cancer
- Burosumab (Crysvita)
- Cerliponase Alfa (Brineura)
- Cetuximab (Erbitux)
- Elotuzumab (Empliciti)
- Eribulin Mesylate (Halaven)
- Exondys 51 (eteplirsen)
- Ibalizumab-uiyk (Trogarzo)
- Inotuzumab ozogamicin (Besponsa)
- Irinotecan Liposomal (Onivyde)
- Omacetaxine mepesuccinate (Synribo)
- Polymerized Sucralfate Malate Paste (ProThelial)
- Siltuximab (Sylvant)
- Treatment of Hereditary Amyloidosis
- Vyondys 53 (Golodirsen)
The following new retail pharmacy Utilization Management program was effective 10/1/2021:
- Ivermectin Quantity Limit
The following new retail pharmacy Utilization Management programs are effective 1/1/2022:
- Empaveli Prior Authorization/Quantity Limit Program
- Long-acting Insulin Prior Authorization
- SGLT-2 Inhibitors and Combinations Prior Authorization
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.
- Abatacept (Orencia) IV
- Aducanumab-avwa (Aduhelm)
- Agalsidase beta (Fabrazyme)
- Alemtuzumab (Lemtrada)
- Alglucosidase alfa (Lumizyme)
- Burosumab (Crysvita)
- Casimersen (Amondys-45)
- Cerliponase Alfa (Brineura)
- Drug Indications
- Eculizumab (Soliris) and Ravulizumab (Ultomiris)
- Edaravone (Radicava)
- Elosulfase alfa (Vimizim)
- Emapalumab-lzsg (Gamifant)
- Eptinezumab-jjmr (Vyepti)
- Evinacumab-dgnb (Evkeeza)
- Exondys 51 (eteplirsen)
- Galsulfase (Naglazyme)
- Givosiran (Givlaari)
- Golimumab (Simponi Aria)
- Hydroxyprogesterone Caproate Injection as a Technique to Reduce Preterm Birth in High-Risk Pregnancies
- Idursulfase (Elaprase)
- IL-1 and IL-1b Blockers
- Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
- Inebilizumab-cdon (Uplizna)
- Laronidase (Aldurazyme)
- Lumasiran (Oxlumo)
- Luspatercept (Reblozyl)
- Medications and Diabetic Supplies Payable on the Pharmacy Benefit
- Monoclonal Antibodies for the Treatment of Eosinophilic Conditions
- Natalizumab (Tysabri)
- Nusinersen (Spinraza)
- Ocrelizumab (Ocrevus)
- Omalizumab (Xolair)
- Onasemnogene abeparvovec (Zolgensma)
- Pegloticase (Krystexxa)
- Portable External Infusion Pump
- Sebelipase alfa (Kanuma)
- Teprotumumab-trbw (Tepezza)
- Treatment of Gaucher Disease
- Treatment of Hereditary Amyloidosis
- Ustekinumab (Stelara) IV
- Vestronidase alfa-vjbk (Mepsevii)
- Viltolarsen (Viltepso)
- Voretigene Neparvovec-rzyl (Luxturna)
- Vyondys 53 (golodirsen)