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.
Medicaid Expansion Updates
Note: There may be corresponding policies for our Commercial lines of business.
The following Medicaid Expansion medical drug prior authorization policies are new and effective Aug 1, 2025:
- Revakinagene taroretcel-lwey (Encelto)
- Zenocutuzumab-zbco (Bizengri)
The following Medicaid Expansion medical drug prior authorization policies are revised and effective Aug 1, 2025:
- Bevacizumab (Avastin) and Bevacizumab Biosimilars
- Crizanlizumab-tmca (Adakveo)
- Efgartigimod (Vyvgart) and Efgartigmod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
- Epcoritamab-bysp (Epkinly)
- Etranacogene dezaparvovec (Hemgenix)
- Intravitreal Implants
- Ipilimumab (Yervoy)
- Lifileucel (Amtagvi)
- Omalizumab (Xolair)
- Polatuzumab vedotin-piiq (Polivy)
- Pralatrexate (Folotyn)
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Tafasitamab-cxix (Monjuvi)
The following Medicaid Expansion medical drug policies were reviewed with no clinical content change:
- Elranatamab-bcmm (Elrexfio)
- Eteplirsen (Exondys 51)
- Lecanemab (Leqembi)
- Lovotibeglogene autotemcel (Lyfgenia)
- Medication Therapy Management Services (MTMS)
- Mogamulizumab-kpkc (Poteligeo)
- Olipudase alfa-rpcp (Xenpozyme)
- Pegloticase (Krystexxa)
- Spesolimab (Spevigo)
- Talquetamab-tgvs (Talvey)
Commercial Updates
The following Commercial medical drug policies are new and effective Aug. 1, 2025:
*see www.gatewaypa.com/policydisplay/52 on or after Aug. 1, 2025.
- Emrelis (telisotuzumab vedotin-tllv)
- Imaavy (nipocalimab-aahu)
- Zevaskyn (prademagene zamkikeracel)
The following Commercial prior authorization medical drug policies have revisions effective July 31, 2025:
*see www.gatewaypa.com/policydisplay/52
- Bevacizumab oncology
- Bizengri
- Denosumab
- Enhertu
- Folotyn
- Hyaluronic Acid Derivatives
- Kadcyla
- Margenza
- Paclitaxel Albumin-Bound
- Pemetrexed
- Perjeta
- Phesgo
- Susvimo
- Synribo
- Trastuzumab IV
- Trastuzumab SQ
- Vyloy
- Vyvgart
- Zynlonta
- Zynyz
The following Commercial post service claim edit medical drug policies have revisions effective July 1, 2025:*see www.gatewaypa.com/policydisplay/52.
- Dysport
- Fulvestrant
- Iluvien
- Myobloc
- Ozurdex
- Retisert
- Xeomin
- Yutiq
The following retail pharmacy Utilization Management programs are new:
- Wakix Prior Authorization with Quantity Limit
- Effective July 1, 2025, for NetResults Formulary
- Already active for Commercial and Health Insurance Marketplace Formularies
- Crenessity Prior Authorization with Quantity Limit
- Effective Aug. 1, 2025, for NetResults, Commercial and Health Insurance Marketplace Formularies
- Tryngolza Prior Authorization with Quantity Limit
- Effective Aug. 1, 2025, for NetResults, Commercial and Health Insurance Marketplace Formularies
