District offices in Bismarck, Grand Forks and Minot are closed June 10-11 for staff training. We will reopen June 12. For help, contact us.
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BCBSND district offices closed June 10-11
District offices in Bismarck, Grand Forks and Minot are closed June 10-11 for staff training. We will reopen June 12. For help, contact us.
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
Medical Pharmacy
The following Commercial prior authorization medical drug policies are new and effective July 1, 2026:
*see www.gatewaypa.com/policydisplay/52 on or after July 1, 2026
The following Commercial prior authorization medical drug policies have updates effective July 1, 2026:
*see www.gatewaypa.com/policydisplay/52 on or after July 1, 2026
The following Commercial drug policy will require prior authorization effective July 1, 2026:
*see www.gatewaypa.com/policydisplay/52 on or after July 1, 2026
Retail Pharmacy
The following retail pharmacy Utilization Management (UM) programs are being retired effective July 1, 2026:
The following retail pharmacy Utilization Management (UM) programs have updates effective July 1, 2026:
*see www.myprime.com/en/forms.html on or after July 1, 2026
UM Program Name | Program Type | Formulary | Update for Provider Letter |
Acute Migraine Agents | PAQL | Commercial, HIM, NetResults | *Clinical criteria and quantity limit criteria update |
Alternative Dosage Form | PAQL | NetResults | *New target agent: Atmeksi |
ATTR Amyloidosis | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Biologic Immunomodulators | PAQL | Commercial, HIM, NetResults | *New target agent, Icotyde |
Cablivi | QL | Commercial, HIM, NetResults | *No changes on annual review |
Calcitonin Gene-Related Peptide (CGRP) | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
Cannabidiol | PA(QL) | Commercial, HIM, NetResults | *Clinical criteria update and addition of quantity limit and quantity limit criteria |
Cardiac Myosin Inhibitors (previously Camzyos) | PAQL | Commercial, HIM, NetResults | *Program name change from "Camzyos" to "Cardiac Myosin Inhibitors" |
Cibinqo | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Constipation Agents | PAQL | NetResults | *Clinical criteria update |
Continuous Glucose Monitor | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Coverage Exception | other | NetResults, HIM | *Removed Litfulo, Leqselvi, and Olumiant for Alopecia Areata as exclusions |
Erectile Dysfunction - PDE 5 Inhibitors | QL | NetResults | *Program name change |
Familial Chylomicronemia Syndrome (FCS) | PAQL | Commercial, HIM, NetResults | *Addition of Redemplo to PAQL program and clinical criteria update |
Fintepla | PAQL | NetResults | *Clinical criteria update |
Gabapentin ER | STQL | ST: Commercial, HIM | *No changes on annual review |
Galafold | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Glucose Test Strips and Meters | PAQL | PA: commercial | *No changes on annual review |
Growth Hormone | PA | Commercial, HIM, NetResults | *Clinical criteria update |
Harliku | PAQL | NetResults | *Clinical criteria update |
HSDD | PAQL | NetResults | *Clinical criteria update |
IL-1 Inhibitors | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
IL-4 Inhibitor | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Imcivree | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Insomnia Agents | ST/QL | ST: Commercial, HIM | *No changes on annual review |
Joenja | PAQL | NetResults | *Clinical criteria update |
Jynarque | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Leucovorin | PAQL | NetResults | *No changes on annual review |
Low Molecular Weight Heparins (LMWH) and Arixtra | QL | Commercial, HIM, NetResults | *Program being retired |
Lupus | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Lyrica and Savella | ST/QL | ST: Commercial and HIM | *No changes on annual review |
Medical Indications for Contraceptives | PA | Commercial, NetResults | *No changes on annual review |
Northera | PAQL | Commercial, HIM, NetResults | *Program being retired |
Otezla | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Oxybate | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Pancreatic Enzymes | PA | Commercial, HIM | *No changes on annual review |
PCSK9 Inhibitors | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
Pulmonary Arterial Hypertension | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Pyrukynd | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
Radicava | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
SA Oncology | PAQL | Commercial, HIM, NetResults | *New target agent: Lifyorli |
Samsca | QL | Commercial, HIM, NetResults | *Clinical criteria update |
Skyclarys | PAQL | NetResults | *No changes on annual review |
Spevigo | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Subcutaneous Furosemide | PAQL | Commercial, HIM, NetResults | *Program name change from "Furoscix" to "Subcutaneous Furosemide" |
Substrate Reduction Therapy | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Sunosi | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Tezspire | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Thrombopoietin Receptor Agonists, Tavalisse, and Wayrilz | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Triptans | STQL | Commercial, HIM, NetResults | *Clinical criteria update |
Vijoice | PAQL | NetResults | *Clinical criteria update |
Weight Loss Agents | PAQL | Commercial, HIM, NetResults | *Removed target agents: benzphetamine, phendimetrazine, diethylpropion |
Weight Management | PAQL | Commercial, HIM, NetResults | *New target agent: Foundayo |
Zokinvy | PAQL | Commercial, HIM, NetResults | *No changes on annual review |