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
Medical Pharmacy
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 June 1, 2026:
- Donanemab (Kisunla)
- Zopapogene Imadenovec-drba (Papzimeos)
The following Medicaid Expansion prior authorization medical drug policies have revisions effective June 1, 2026:
- Ado-trastuzumab emtansine (Kadcyla)
- Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro)
- Added new drug Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro)
- Bendamustine
- Betibeglogene autotemcel (Zynteglo)
- Carfilzomib (Kyprolis)
- Certolizumab (Cimzia)
- Chimeric Antigen Receptor Therapy for Multiple Myeloma
- Eculizumab and Ravulizumab (Ultomiris)
- Efgartigimod (Vyvgart) and Efgartigmod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
- Epcoritamab-bysp (Epkinly)
- Evinacumab-dgnb (Evkeeza)
- Granulocyte Colony-Stimulating Factors
- Immune Globulin Therapy
- Inebilizumab-cdon (Uplizna)
- Inotuzumab ozogamicin (Besponsa)
- Intravitreal Injections
- Added ranibizumab-leyk (Nufymco™)
- Ipilimumab (Yervoy)
- Ixabepilone (Ixempra)
- Lecanemab (Leqembi)
- Margetuximab-cmkb (Margenza)
- Medication Therapy Management Services (MTMS)
- Mirikizumab-mrkz (Omvoh) IV
- Monoclonal Antibodies for the Treatment of Eosinophilic Conditions
- Mosunetuzumab-axgb (Lunsumio)
- Nusinersen (Spinraza)
- Obecabtagene autoleucel (Aucatzyl)
- Ocrelizumab (Ocrevus)
- Olipudase alfa-rpcp (Xenpozyme)
- Onasemnogene abeparvovec-brve (Itvisma)
- Pegloticase (Krystexxa)
- Ramucirumab (Cyramza)
- Spesolimab (Spevigo)
- Tocilizumab
- Treatment of Hereditary Amyloidosis
- Tremelimumab (Imjudo)
- Ustekinumab IV
- Added Starjemza
- Zolbetuximab-clzb (Vyloy)
The following Medicaid Expansion medical drug policies were reviewed and have no changes:
- Blinatumomab (Blincyto)
- Brentuximab Vedotin (Adcetris)
- Crizanlizumab-tmca (Adakveo)
- Elranatamab-bcmm (Elrexfio)
- Eteplirsen (Exondys 51)
- Etranacogene dezaparvovec (Hemgenix)
- Intravitreal Implants
- Loncastuximab tesirine-lpyl (Zynlonta)
- Mogamulizumab-kpkc (Poteligeo)
- Panitumumab (Vectibix)
- Plerixafor (Mozobil)
- Polatuzumab vedotin-piiq (Polivy)
- Pralatrexate (Folotyn)
- Tagraxofusp-erzs (Elzonris)
- Talquetamab-tgvs (Talvey)
- Tarlatamab-dlle (Imdelltra)
- Tisotumab vedotin-tftv (Tivdak)
- Trilaciclib (Cosela)
- Zanidatamab (Ziihera)
- Zenocutuzumab-zbco (Bizengri)
- Ziv-aflibercept (Zaltrap)
