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 prior authorization medical drug policies have revisions effective March 1, 2026:
- Alglucosidase alfa (Lumizyme) and Avalglucosidase alfa-ngpt (Nexviazyme)
- Alpha1-Proteinase Inhibitors
- Cipaglucosidase alfa-atga (Pombiliti)
- Lovotibeglogene autotemcel (Lyfgenia)
- Lurbinectedin (Zepzelca)
- Obinutuzumab (Gazyva)
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Tocilizumab
- Treatment of Gaucher Disease
- Ustekinumab IV
The following Medicaid Expansion medical drug policies were reviewed and have no changes:
- Abatacept (Orencia) IV
- ADAMTS13, recombinant-krhn (Adzynma)
- Amivantamab-vmjw (Rybrevant)
- Chimeric Antigen Receptor Therapy for Leukemia and Lymphoma
- Chimeric Antigen Receptor Therapy for Multiple Myeloma
- Cipaglucosidase alfa-atga (Pombiliti)
- Ibalizumab-uiyk (Trogarzo)
- Imetelstat (Rytelo)
- Immune Globulin Therapy
- Infliximab
- Isatuximab-irfc (Sarclisa)
- Luspatercept (Reblozyl)
- Rozanolixizumab-noli (Rystiggo)
- Teplizumab-mzwv (Tzield)
The following Medicaid Expansion medical drug policy has a coding update effective Jan. 1, 2026:
- Gonadotropin Releasing Hormones (GnRHs) Analogs
Medicaid Expansion and Commercial Updates
The following Medicaid Expansion and Commercial medical drug policy has a coding update effective Jan. 1, 2026:
- Implantable Hormone Replacement Pellets
Commercial Updates
Medical Pharmacy
The following Commercial prior authorization medical drug policies are new and effective March 1, 2026:
*see www.gatewaypa.com/policydisplay/52 on or after March 1, 2026
- Blenrep (belantamab mafodotin-blmf)
- Itvisma (onasemnogene abeparvovec-brve)
Retail Pharmacy
The following retail pharmacy Utilization Management (UM) program is effective March 1, 2026:
*see www.myprime.com/en/forms.html on or after March 1, 2026
- Anzupgo Prior Authorization Quantity Limit Program
- Commercial and HIM Formularies
The following Commercial medical drug policies have coding updates effective Jan. 1, 2026:
New Code | Brand Name (Generic Name) |
C9308 | Kyxata (carboplatin) |
C9307 | Lynozyfic (linvoseltamab-gcpt) |
J7299 | Contraceptive Management |
The following retail pharmacy administrative actions occurred from Nov. 24, 2025, to Dec. 29, 2025:
UM Program Name | Program Type | Formulary | Effective Date | Summary of Changes |
Ophthalmic Prostaglandins | Quantity Limit; Step Therapy | Commercial, HIM, NetResults | Dec. 29, 2025 | Addition of Omlonti |
Self-Administered Oncology Agents | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 29, 2025 | Addition of Hyrnuo |
Interleukin (IL-1) Inhibitors | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 22, 2025 | Addition of Otezla XR, Rhapsido, and Tyruko to contraindicated table |
Lupus | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 22, 2025 | Addition of Otezla XR, Rhapsido, and Tyruko to contraindicated table |
Spevigo (spesolimab-sbzo) | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 22, 2025 | Addition of Otezla XR, Rhapsido, and Tyruko to contraindicated table |
Multiple Sclerosis Agents | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 22, 2025 | Addition of asterisk to Mavenclad in FDA table and preferred agent table to identify availability of generic; auto-roll-in of new generic therapy pack |
Self-Administered Oncology Agents | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 15, 2025 | Addition of Komzifti |
Atypical Antipsychotics | Quantity Limit; Step Therapy | Commercial, HIM, NetResults | Dec. 8, 2025 | Removed Clozapine ODT as a step target due to generic only availability |
Pulmonary Arterial Hypertension | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 8, 2025 | Addition of new Tyvaso DPI strengths to PA and QL Tables |
Dry Eye Disease | Prior Authorization; Quantity Limit | NetResults | Dec. 1, 2025 | Removed auto-roll-in single-use Restasis NDCs (00480407630 & 00480407660) from Restasis multidose QL target entry |
Self-Administered Oncology Agents | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 1, 2025 | Addition of Pazopanib 400 mg |
Biologic Immunomodulators | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Dec. 1, 2025 | Addition of Ustekinumab-aauz |
Biologic Immunomodulators | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Nov.24, 2025 | Addition of Starjemza |
Alternative Dosage Form | Prior Authorization; Quantity Limit | NetResults | Nov.24, 2025 | Addition of Tonmya as target |
The following retail pharmacy administrative actions will occur March 1, 2026:
UM Program Name | Program Type | Formulary | Summary of Changes |
Biologic Immunomodulators OP2 | Prior Authorization; Quantity Limit | Commercial, HIM, NetResults | Added Omvoh 200 mg/2mL syringe and pen to QL Target Agents |
