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.
Brand name and generic prescription medications or drugs reimbursed at maximum payment levels.
Forms and Links:
2021 Drug Formulary List - updated April 2021
Latest Additions and Deletions - updated April 2021
2020 BlueCare, BlueDirect, BlueEssential, BluePartner and SimplyBlue Formulary - updated April 2021
2021 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated April 2021
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:
See the guidelines for prior approval or have restricted-use drugs:
Forms and Links:
Restricted-Use Prior Approval Drugs - updated April 2021
Restricted-Use Opioids - updated April 2021
Restricted-Use Step Therapy Drugs - updated April 2021
Restricted-Use Insulin - updated August 2020
Restricted-Use Drug Dispensing Limits (BCBSND Formulary) - updated April 2021
Restricted-Use Drug Dispensing Limits (BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary) - updated April 2021
Retail Pharmacy Medical Policy
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 April 2021
Value Based Design (VBD) Drug List
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.
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.
Information specific to NetResults
2021 NetResults Formulary - updated April 2021
2021 NetResults HSA Preventive Drug List - updated November 2020
NetResults Value Based Design Drug List - updated November 2020
NetResults Restricted Use List - Opioids - updated April 2021
NetResults Quantity Limit Program Summary - updated April 2021