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 retail pharmacy Utilization Management (UM) programs have updates effective June 1, 2026:
*see www.myprime.com/en/forms.html on or after June 1, 2026.
UM Program Name | Program Type | Formulary | Update for Provider Letter |
Interstitial Lung Disease (ILD) | PAQL | Commercial, HIM, NetResults | *clinical criteria update |
The following retail pharmacy administrative actions will occur June 1, 2026:
UM Program Name | Program Type | Formulary | Summary of Changes |
ADHD | QL | Commercial, HIM, NetResults | Addition of Arynta |
Alternative Dosage Form | PAQL | NetResults | Addition of Desmoda |
Anzupgo | PAQL | Commercial, HIM | Added Exdensur and tofacitinib to "Agents NOT to be used Concomitantly" table |
Biologic Immunomodulators | PAQL | Commercial, HIM, NetResults | Addition of Atozma |
Erectile Dysfunction PDE5 Inhibitors | QL | NetResults | Addition of Vybrique |
Hereditary Angioedema | PAQL | Commercial, HIM, NetResults | Addition of Orladeyo packets |
IL-13 Antagonist | PAQL | Commercial, HIM, NetResults | Added Exdensur and tofacitinib to "Agents NOT to be used Concomitantly" table |
IL-31Inhibitor | PAQL | Commercial, HIM, NetResults | Added Exdensur and tofacitinib to "Agents NOT to be used Concomitantly" table |
IL-5 Inhibitor | PAQL | Commercial, HIM, NetResults | Added Exdensur and tofacitinib to "Agents NOT to be used Concomitantly" table |
Phosphate Binder | STQL | ST: HIM, QL: HIM, NetResults | Addition of generic Auryxia |
Rhapsido | PAQL | Commercial, HIM, NetResults | Added Exdensur and tofacitinib to "Agents NOT to be used Concomitantly" table |
Xolair | PAQL | Commercial, HIM, NetResults | Added Exdensur and tofacitinib to "Agents NOT to be used Concomitantly" table |
Zeposia | PAQL | Commercial, HIM, NetResults | Added Exdensur and tofacitinib to "Agents NOT to be used Concomitantly" table |
The following Commercial medical drug policies have coding updates effective April 1, 2026:
New Code | Brand Name (Generic Name) |
C9309 | Itvisma (onasemnogene abeparvovec-brve) |
J1569 | Gammagard Liquid ERC (intravenous immune globulin) |
J1569 | Gammagard Liquid ERC SQ (subcutaneous immune globulin) |
