High call volumes
Our provider services may be experiencing higher than normal call volumes this week. We encourage you to utilize alternative forms of communication, such as the Availity Essentials Provider Portal
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.
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.
Pharmacy search
Search for participating online and retail pharmacies.
Drug formulary
Brand name and generic prescription medications or drugs reimbursed at maximum payment levels.
Forms and links:
2025 Drug Formulary List
Latest Additions and Deletions
2025 Health Ins. Market Individual Small Group 6 T Formulary
2024 Health Ins. Market Individual Small Group 6 T Formulary
2025 Health Ins. Market Individual Small Group 4 T Formulary
2024 Health Ins. Market Individual Small Group 4 T Formulary
Nonpayable drugs
Prescription drugs not covered by BCBSND.
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:
See the guidelines for prior approval 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 pharmacy medical policies which are available on their website.
Medical Drug Policies and Prior Authorizations
We partner with the Medical Pharmacy Solutions team at Prime Therapeutics (Prime) to process and manage certain clinician administered drugs processed under the medical benefit.
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.
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 benefit plan materials to determine coverage. Contact customer service using the number on the back of your Insurance ID card with any questions.
2025 HSA BlueDirect, BluePartner HDHP Preventive Drug
2024 HSA BlueDirect, BluePartner HDHP Preventive Drug
2025 NGF HSA Preventive Drug
2024 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.
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
