Provider Pharmacy Information

The BCBSND pharmacy program is built around a holistic view of health. It also provides tools to help collectively assess the value of drug benefits, monitor drug safety and improve health outcomes for North Dakotans.

Note: Before following information on this page, always confirm the member’s migration status first. Use the member’s current ID card and eligibility results to determine whether migrated or non-migrated instructions apply. Non-migrated members’ ID numbers will have 12 digits after the prefix, while migrated members will have a shorter member ID numbers (9 digits instead of 12 digits after the prefix) and new Customer Service phone numbers.

Drug shortages

Drug shortages can occur due to manufacturing and quality problems, delays and discontinuations. The U.S. Food and Drug Administration (FDA) keeps track of drug shortages. Manufacturers provide concerns about drug shortages to the FDA so they can proactively work together to address them.

Visit the FDA’s drug shortages database for more information.

Drug formulary

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

2027 Health Ins. Market Individual, Small Group 6 T Formulary (as of October 2026)

2027 Health Ins. Market Individual Small Group 4 T Formulary (as of October 2026)

2027 BCBSND Standard 6 T Formulary (as of October 2026)

Prior authorization

Prior Authorization Flyer

Quantity Limits

Quantity Limit List

Specialty drugs

The Specialty Drugs List will be available Jan. 1, 2027.

Optimum Value Medication List

The Optimum Value Medication List will be available by Jan. 1, 2027.

Comprehensive Medication Management (CMM)

CMM services are optional services and will be available to eligible, fully insured members. CMM services are pharmacist-led services that evaluate an eligible member’s medication regimen to ensure they are appropriate, effective, and safe. The pharmacist providing CMM services must be enrolled with Outcomes to provide CMM services. Pharmacist enrollment can be completed at outcomes.com. CMM services would be documented through outcomes.com. Licensed pharmacists contracted with Outcomes should be reaching out to members’ medication prescribers to collaborate concerning CMM services.

Drug shortages

Visit the FDA’s drug shortages database for more information.

Pharmacy search

Search for participating online and retail pharmacies.

Pharmacy Network

NetResults Formulary

Information specific to NetResults

2027 NetResults Formulary (as of October 2026)

2026 NetResults Formulary

2026 NetResults HSA Preventive Drug List

2026 NetResults Value Based Design (VBD) Drug List

NetResults Restricted Use List - Opioids

NetResults Quantity Limit Program Summary

NetResults Alternative Medication Table

Drug formulary

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

Forms and links:

2027 BCBSND Formulary (as of October 2026)

2026 BCBSND Formulary
Latest Additions and Deletions

2027 Health Ins. Market Individual, Small Group 6 T Formulary (as of October 2026)

2026 Health Ins. Market Individual, Small Group 6 T Formulary
2025 Health Ins. Market Individual Small Group 6 T Formulary

2026 Health Ins. Market Individual Small Group 4 T Formulary
2025 Health Ins. Market Individual Small Group 4 T Formulary

Nonpayable drugs

Prescription drugs not covered by BCBSND.

Nonpayable Drug List

Restricted-use drugs

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

To submit a prior approval authorization request:

Submit request electronically through CoverMyMeds
If you have not registered on this site, please do so.
OR
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 authorization or have restricted-use drugs:

Forms and Links:

Restricted-Use Prior Approval Drugs
Restricted-Use Opioids
Restricted-Use Step Therapy Drugs
Restricted-Use Drug Dispensing Limits (BCBSND Formulary)
Restricted-Use Drug Dispensing Limits (Qualified Health Plans)

Retail pharmacy medical policy

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

Medical Drug Policies and Prior Authorizations

We partner with Prime Therapeutics (Prime) to process and manage certain clinician administered drugs processed under the medical benefit.

Medical and Retail Benefit Pharmacy Drug Policy Updates ›

Specialty 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

Value Based Design (VBD) drug list

2026 NonNR Value Based Design (VBD) Drug

2026 BlueCare, BlueValue, DakotaBlue Value Based Design (VBD) Drug List
2025 BlueCare, BluePartner nonHDHP, BluePrime, DakotaBlue Value Based Design (VBD) Drug

ACA Preventive drug list

2026 ACA Preventive Drug
2025 ACA Preventive Drug

2026 NetResults ACA Preventive Drug List
2025 NetResults ACA Preventive 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 patient’s benefit plan materials to determine coverage. Contact the Provider Contact Center using the number on the back of your patient’s member ID card with any questions.

2026 BlueDirect HDHP Drug List
2025 HSA BlueDirect, BluePartner HDHP Preventive Drug

2026 NGF HSA Preventive Drug

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

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
Routes of Administration Self-Administered Drug List

Our Partners in Health:
Members
Employers
Producers

Fargo (Headquarters)
4510 13th Ave. S.
Fargo, N.D., 58121

Medical Policy Search

Provider Pharmacy Information