PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Blue Cross Blue Shield of North DakotaCommercial · Prior Auth · Pharmacy · ND · Pharmacy, Oncology, Allergy & Immunology +4 moreMedium impact

Pharmacy Policies Available Online

Effective date
Sep 9, 2026
Identified
Jul 15, 2026

Summary

Blue Cross Blue Shield of North Dakota updated its commercial pharmacy policies, and the revisions to the commercial prior authorization medical drug policies are effective September 9, 2026. Revisions to the commercial post service claim edit medical drug policies are effective August 1, 2026. Many of the prior authorization policies now state the number of days allowed for initial and renewal authorization durations, replace specific contraindications in the Universal Criteria with general language that the member does not have any FDA contraindications, and add covered ICD-10 diagnosis codes in Appendix 1.

Get alerts when payers change rules like this one

We check Blue Cross Blue Shield of North Dakota and other payers every day and email you when a change matches your specialty and state.

Get Blue Cross Blue Shield of North Dakota alertsPolicy Monitoring is free. No card required.

What to do

Action · 6 steps
01Already effective September 9, 2026 for the commercial prior authorization medical drug policies and August 1, 2026 for the commercial post service claim edit medical drug policies: Billing team, review the revised Length of Authorization, Universal Criteria and Appendix 1 covered diagnosis code sections for the drugs you bill at www.gatewaypa.com/policydisplay.
02For Amvuttra, add E85.4 (organ-limited amyloidosis, related to ATTR-CM) as a covered diagnosis code.
03For Prolia, Xgeva and Zometa, C50.A0 through C50.A2 (related to breast cancer) were added, and for Prolia and Xgeva, Z85.46 (related to prostate cancer) was added.
04Already effective October 1, 2026: stop using discontinued ICD-10 code F64.9 and use F64.A for gender dysphoria, as the source states that F64.9 is discontinued and F64.A is effective on that date.
05For Zevaskyn, use HCPCS code J3389, which the source says was added, and stop using J3590, which the source says was removed.
06For Camcevi ETM, the source adds NDC 69448-0024-xx and removes unclassified code J3490.

Codes mentioned

E85.4C50.A0C50.A2Z85.46C43.10D72.110D72.111D72.119D37.3C83.10C83.11C83.12C83.13C83.14C83.15C83.16C83.17C83.18M05.AG24.8F64.9F64.AC06.9C07C08.9D37.039C55Z85.42J1950J1952J1954J9003J9217J9154J3389J3590J3490

Original notice

Pharmacy Policies Available Online
bcbsnd.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account