MedicaidPrior AuthHigh impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology, Endocrinology +3 more·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 23, 2026
Summary
Blue Cross Blue Shield of North Dakota updated Medicaid Expansion pharmacy policies with new prior authorizations effective August 1, 2026, and new HCPCS codes effective July 1, 2026. Multiple specialty drug policies were revised with updated criteria for cancer treatments, immune therapies, and other high-cost medications.
Action Required
By July 1, 2026: Billing team must update system with new HCPCS codes J9062, Q5169, J1577, Q5170, J2361, J3405, and Q5164. By August 1, 2026: Update prior authorization requirements for new drugs including Linvoseltamab-gcpt, Octreotide acetate, Pegzilarginase-nbln, and Talimogene laherparepvec. Review and update criteria for existing specialty drugs with revised policies including cancer treatments and immune therapies. Contact provider service at 833-777-5779 for Medicaid Expansion questions.