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.
Commercial Updates
Note: There may be corresponding policies for our Commercial lines of business.
The following Medicaid Expansion medical drug prior authorization policy is new and effective July 1, 2025:
- Obecabtagene autoleucel (Aucatzyl)
The following Medicaid Expansion medical drug prior authorization policies are revised and effective June 1, 2025:
- Bendamustine
- Blinatumomab (Blincyto)
- Cetuximab (Erbitux)
- Eculizumab and Ravulizumab
- Guselkumab (Tremfya)
- Ipilimumab (Yervoy)
- Loncastuximab tesirine-lpyl (Zynlonta)
- Lurbinectedin (Zepzelca)
- Margetuximab-cmkb (Margenza)
- Nusinersen (Spinraza)
- Panitumumab (Vectibix)
- Plerixafor (Mozobil)
- Ramucirumab (Cyramza)
- Risankizumab-rzaa (Skyrizi) IV
- Tisotumab vedotin-tftv (Tivdak)
- Treatment of Hereditary Amyloidosis
The following Medicaid Expansion medical drug policies have a coding change effective July 1, 2025:
- Intravitreal Injections
- Medications and Diabetic Supplies Payable on the Pharmacy Benefit
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Ustekinumab IV
- Zolbetuximab-clzb (Vyloy)
- Zanidatamab (Ziihera)
The following Medicaid Expansion medical drug policies were reviewed with no clinical content change:
- Ado-trastuzumab emtansine (Kadcyla)
- Carfilzomib (Kyprolis)
- Drug Indications
- Fulvestrant (Faslodex)
- Inotuzumab ozogamicin (Besponsa)
- Ixabepilone (Ixempra)
- Mirvetuximab soravtansine-gynx (Elahere)
- Mosunetuzumab-axgb (Lunsumio)
- Portable External Infusion Pump
- Tagraxofusp-erzs (Elzonris)
- Tarlatamab-dlle (Imdelltra)
- Tremelimumab (Imjudo)
- Trilaciclib (Cosela)
- Ziv-aflibercept (Zaltrap)
The following Medicaid Expansion medical drug policy was retired June 1, 2025:
- Brexanolone (Zulresso)
Medicaid Expansion Updates
The following Commercial medical drug policy has no clinical content change:
- Drug Indications
The following Commercial medical drug prior authorization policies are new and effective July 1, 2025:
*see www.gatewaypa.com/policydisplay/52 on/or after July 1, 2025
- Bomyntra (denosumab-bnht)
- Conexxence (denosumab-bnht)
- Denosumab-bnht
- Jobevne (bevacizumab-nwgd)
- Penpulimab-kcqx
The following Commercial medical drug prior authorization policies have revisions effective June 27, 2025:
*see www.gatewaypa.com/policydisplay/52 on/or after June 27, 2025.
- Adcetris
- Amondys45
- Amvuttra
- Bevacizumab oncology
- Darzalex IV
- Darzalex SQ
- Elrexfio
- Elzonris
- Enjaymo
- Erbitux
- Exondys51
- Feraheme
- GCSF LA
- Injectafer
- Izervay
- Kyprolis
- Monoferric
- Omisirge
- Opdivo
- Piasky
- Pluvicto
- Qutenza
- Reblozyl
- Rituximab IV
- Ryoncil
- Ryplazim
- Rytelo
- Sarclisa
- Talvey
- Tecvayli
- Tevimbra
- Uplizna
- Ustekinumab
- Viltepso
- Vyondys53
- Yervoy
The following Commercial post service claim edits medical drug policies have minor revisions effective June 1, 2025:
*see www.gatewaypa.com/policydisplay/52 on/or after June 1, 2025.
- Bortezomib
- Dextenza
- Empliciti
- Leuprolide depot
The following Commercial medical drug policies have a coding change effective July 1, 2025:
*see www.gatewaypa.com/policydisplay/52 on/or after July 1, 2025.
- Aucatzyl
- Bizengri
- Imuldosa IV
- Lenmeldy
- Opdivo Qvantig
- Opuviz
- Steqeyma IV
- Unloxcyt
- Vyloy
- Yesintek IV
- Ziihera
