Medical and Retail Benefit Drug Policy Updates

Blue Cross Blue Shield of North Dakota is committed to providing members with access to high-quality healthcare consistent with evidence-based, nationally recognized clinical criteria and guidelines. To ensure value to our members, we're changing the way we manage certain medical and retail benefit drugs. 

How It Works

Before requesting prior authorization, always:

  1. Confirm the member’s status first. Use the member’s current ID card and eligibility results to determine whether migrated or non-migrated instructions apply. Migrated members will have new information, such as a shorter member ID numbers (9 digits instead of 12 digits after the prefix) and new Customer Service phone numbers.
  2. Verify the member's eligibility in Availity Essentials.
  3. If the member is non-migrated, providers should continue to access policy and prior authorization workflows as they do today. If the member has migrated, providers can access medical and retail benefit policies starting Jan. 1, 2027. For a summary of updates, refer to the below information. 

Medical Benefit Drugs
PA requests: https://www.gatewaypa.com/ or call 1-800-424-1708 to submit a prior authorization request.
PA and post service claim edit (PSCE) policies: https://www.gatewaypa.com/policydisplay/52

Retail Benefit Drugs
PA requests: CoverMyMeds, Fax 1-855-212-8110, or Phone 1-877-277-7912
PA policies: drug policies

Retail and Medical Benefit Drug Prior Authorization list effective Jan. 1, 2027, for migrated members:

View Prior Authorization List

Retail Benefit Drug Quantity Limit list effective Jan. 1, 2027, for migrated members:

View Quantity Limit List

Note: The updates listed below are as of September 2026. Pharmacy information changes often, so providers should review this page regularly for the latest updates or subscribe to HealthCareNews for notifications. For retail benefit drugs that currently require prior authorization, some criteria are changing for migrated members starting Jan. 1, 2027. Criteria changes include both administrative and clinical updates.