CommercialPrior AuthMedium impact
Commercial Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Endocrinology, Cardiology, Internal Medicine +1 more·Pharmacy
Effective date
May 1, 2026
We identified it
Jun 19, 2026
Summary
BCBS North Dakota updated pharmacy utilization management programs effective May 1, 2026. Changes include clinical criteria updates for PCSK9 inhibitors, addition of new drugs (Sdamlo, Ontralfy, Pokonza) to Alternative Dosage Form programs, and addition of Zepbound Kwikpen to Weight Management prior authorization requirements.
Action Required
By May 1, 2026: Billing team must update prior authorization workflows for PCSK9 inhibitor medications and weight management drug Zepbound Kwikpen. Check www.myprime.com/en/forms.html on or after May 1, 2026 for updated prior authorization forms and clinical criteria. Update pharmacy benefit verification processes to include new drugs Sdamlo, Ontralfy, and Pokonza under Alternative Dosage Form requirements.