CommercialPrior AuthHigh impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology·Pharmacy
Effective date
Apr 14, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota is implementing comprehensive updates to prior authorization policies for multiple specialty cancer and rare disease medications, including changes to authorization durations, eligibility criteria, and coverage requirements. The updates affect oncology drugs like Adcetris, Keytruda, Enhertu, and others, with expanded indications and modified treatment criteria taking effect April 14, 2026.
Action Required
By April 14, 2026: Billing and clinical teams must update prior authorization workflows for all affected specialty medications including Adcetris, Keytruda IV, Enhertu, Erbitux, Darzalex IV, and others. Update authorization duration tracking systems to reflect new day limits. Remove discontinued HCPCS codes C9174 and J9999 from billing systems. Update ICD-10 code crosswalks and ensure new covered indications are properly documented in EMR templates. Train staff on expanded eligibility criteria and new combination therapy approvals to prevent claim denials.