MedicaidPrior AuthMedium impact
Medicaid Expansion Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology, Neurology +3 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
BCBS North Dakota has implemented new and revised prior authorization policies for multiple high-cost specialty medications under Medicaid Expansion, including new requirements for Onasemnogene abeparvovec-brve (Itvisma) and updates to existing policies for drugs like Alemtuzumab, Burosumab, and Ocrelizumab. The changes also add new drugs to existing policy categories and designate Ocrevus Zunovo as non-preferred.
Action Required
By April 1, 2026: Billing team must update prior authorization requirements for all listed specialty medications in billing system for Medicaid Expansion patients. Verify prior authorization is obtained before administering or prescribing Onasemnogene abeparvovec-brve (Itvisma), pegfilgrastim-cbve (Armlupeg), Exdensur, and other revised medications. Update drug formulary preferences to reflect Ocrevus Zunovo as non-preferred. Contact BCBS ND Medicaid Expansion at 833-777-5779 for specific authorization requirements.