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 Aug. 1, 2026:
- Linvoseltamab-gcpt (Lynozyfic)
- Octreotide acetate (Sandostatin LAR) and Lanreotide (Somatuline Depot)
- Pegzilarginase-nbln (Loargys)
- Talimogene laherparepvec (Imlygic)
The following Medicaid Expansion prior authorization medical drug policies have coding changes effective July 1, 2026:
- Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro)
- New HCPCs code Rybrevant Faspro (J9062)
- Granulocyte Colony-Stimulating Factors
- New HCPCs code Armlupeg (Q5169)
- Immune Globulin Therapy
- New HCPCs code Qivigy (J1577)
- Intravitreal Injections
- New HCPCs code Eydenzelt (Q5170)
- Monoclonal Antibodies for the Treatment of Eosinophilic Conditions
- New HCPCs code Exdensur (J2361)
- Onasemnogene abeparvovec-brve (Itvisma)
- New HCPCs code J3405
- Ustekinumab IV
- New HCPCs code Starjemza (Q5164)
The following Medicaid Expansion prior authorization medical drug policies have revisions effective Aug. 1, 2026:
- Cetuximab (Erbitux)
- Updated colorectal cancer criteria
- Chimeric Antigen Receptor Therapy for Leukemia and Lymphoma
- Updated criteria for Tecartus, Breyanzi, Kymirah, and Yescarta
- Removed REMs program information in alignment with FDA discontinuation
- Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro)
- Added indications for Darzalex Faspro
- Fam-trastuzumab Deruxtecan-nxki (Enhertu)
- Updated Breast Cancer Criteria
- Granulocyte Colony-Stimulating Factors
- Updated criteria for Filkri (filgrastim-laha)
- Inclisiran (Leqvio)
- Updated reauthorization criteria based on DHHS PDL Version 2026.4
- Luspatercept (Reblozyl)
- Updated criteria based on the DHHS PDL Version 2026.4
- Nipocalimab-aahu (Imaavy)
- Updated criteria based on the DHHS PDL Version 2026.4
- Obinutuzumab (Gazyva)
- Updated criteria based on DHHS PDL Version 2026.4
- Programmed Death Receptor (PD-1)/ Programmed Death-Ligand (PD-L1) Blocking Antibodies
- Updated criteria for Small Cell Lung Cancer for Tecentriq
- Removed indication for squamous cell carcinoma for Libtayo
- Updated criteria to include expanded indications for Imfinzi, Opdivo Qvantig, Keytruda and Keytruda Qlex
- Rituximab (Rituxan), Rituximab Biosimilars, and Rituximab and Hyaluronidase Human (Rituxan Hycela)
- Updated criteria based on DHHS PDL Version 2026.4
- Rozanolixizumab-noi (Rystiggo)
- Updated criteria to remove Quantitative Myasthenia Gravis (QMG) score component based on the DHHS PDL Version 2026.4
- Teclistamab-cqyv (Tecvayli)
- Added indication for the combination of TECVAYLI® (teclistamab) and DARZALEX FASPRO® (daratumumab and hyaluronidase) for adults with relapsed or refractory multiple myeloma
- Tezepelumab-ekko (Tezspire)
- Updated initial criteria based on the DHHS PDL Version 2026.4
- Tildrakizumab-asmn (Ilumya)
- Updated criteria based on DHHS PDL Version 2026.4
- Trastuzumab (Herceptin), Trastuzumab Biosimilars, and Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
- Updated diagnosis codes
The following Medicaid Expansion medical drug policies were reviewed and have no changes:
- Mirvetuximab soravtansine-gynx (Elahere)
