Provider Pharmacy Information

The BCBSND pharmacy program incorporates our philosophies around a holistic view of health. It also provides tools to help us collectively consider the value of drug benefits, monitor drug safety and improve health outcomes for North Dakotans.

Pharmacy search

Search for participating online and retail pharmacies.

Pharmacy Network

Drug formulary

Brand name and generic prescription medications or drugs reimbursed at maximum payment levels.

Forms and links:

2022 Drug Formulary List - updated April 2022
Latest Additions and Deletions - updated April 2022
2022 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated June 2022
2021 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated June 2022

Nonpayable drugs

Prescription drugs not covered by BCBSND.

Nonpayable Drug List - updated June 2022

Restricted-use drugs

Drugs that have a dispensing limit, step therapy requirement and/or require prior approval from our pharmacy partner, Prime Therapeutics.

To submit a prior approval authorization request: 

  1. Submit request electronically through CoverMyMeds  
    If you have not registered on this site, please do so. 
    OR
  2. If you're unable to submit an electronic request, download a form from the Prime Therapeutics website using one of the links below, complete it and fax it to Prime Therapeutics at 877-480-8130.

See the guidelines for prior approval or have restricted-use drugs: 

Forms and Links:

Restricted-Use Prior Approval Drugs - updated June 2022
Restricted-Use Opioids - updated May 2022
Restricted-Use Step Therapy Drugs - updated January 2022
Restricted-Use Insulin - updated January 2022
Restricted-Use Drug Dispensing Limits (BCBSND Formulary) - updated April 2022
Restricted-Use Drug Dispensing Limits (BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary) - updated April 2022

Retail pharmacy medical policy

We partner with Prime Therapeutics to validate and approve retail pharmacy medical policies which are available on their website.

Speciality drugs

Medications or drugs that are generally high cost and may have other considerations such as special administration, limited availability, unique delivery and dispensing, or unique and/or required patient support or monitoring.

Specialty Drug List - updated June 2022

HSA preventive drugs

Drugs covered under an HSA Preventive Drug benefit.
The HSA Preventive Drug benefit is not included with all benefit plans.  Please review your benefit plan materials to determine coverage.  Contact customer service using the number on the back of your Insurance ID card with any questions.

2022 HSA Preventive Drug - updated January 2022
2021 BlueDirect, BluePartner HDHP Preventive Drug
2022 BlueDirect, BluePartner HDHP Preventive Drug - updated January 2022

Over-the-counter medications

Non-prescription drugs covered by BCBSND when dispensed by a pharmacist upon receipt of a prescription order.

Over-the-Counter Medications List - updated November 2019

Excluded route of administration

A prescription medication or drug with an excluded pharmacy benefit route of administration will reject at pharmacy point of sale and may be covered under the medical benefit.

Routes of Administration Pharmacy Benefit Exclusion List - updated January 2022
Routes of Administration Self-Administered Drug List - updated January 2022

NetResults

Information specific to NetResults

2022 NetResults Formulary - updated April 2022
2022 NetResults HSA Preventive Drug List - updated January 2022
2022 NetResults Value Based Design Drug List - updated January 2022
NetResults Restricted Use List - Opioids - updated May 2022
NetResults Quantity Limit Program Summary - updated April 2022