CommercialPrior AuthMedium impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota·ND · Pharmacy·Pharmacy
We identified it
Oct 6, 2026
Summary
Blue Cross Blue Shield of North Dakota has updated pharmacy prior authorization policies for both Commercial and Medicaid Expansion plans. Commercial lines have five new prior authorization medical drug policies effective December 1, 2026, while Medicaid Expansion has revised policies effective October 1, 2026, with updated HCPCS codes for two drugs. Providers must verify current applicability of the October 1 changes and prepare systems for the December 1 Commercial additions.
Action Required
Before December 1, 2026: Billing team should implement prior authorization requirements in the billing system for the five new Commercial medical drug policies (Fayuvi, Genglycos, Isembyld, Pasatru, and Zanvastro) by accessing the updated policies at www.gatewaypa.com/policydisplay/52 on or after that date. Already effective October 1, 2026: Verify whether the practice has implemented the Medicaid Expansion prior authorization policy revisions for Pivekimab Sunirine-pvzy (Decnupaz) with updated HCPCS code C9313, and Trabectedin with updated HCPCS codes C9312 (Evdi) and J9362 (Yondelis), and confirm current applicability with Provider Service (800-368-2312 for Commercial; 833-777-5779 for Medicaid Expansion).