CommercialPrior AuthMedium impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology, Ophthalmology +3 more·Pharmacy
Effective date
Mar 17, 2026
We identified it
Jun 19, 2026
Summary
BCBS of North Dakota has updated multiple pharmacy prior authorization policies effective March 17, 2026, including changes to drug coverage criteria, authorization periods, dosing limits, and billing codes for various medications including cancer treatments, gene therapies, and specialty drugs.
Action Required
Before March 17, 2026: Billing team must review and update prior authorization requirements for affected specialty medications including Adakveo, Aflibercept, Bavencio, Beqvez, Breyenzi, Casgevy, Danyelza, Elevidys, Gemcitabine, Givlaari, Hemgenix, Imdelltra, and Imfinzi. Update billing system to reflect new authorization periods, dosing limits, and coverage criteria. Remove discontinued codes J3590, C9172, J9999, and C9170 from billing software. Review patient cases for affected medications to ensure compliance with updated criteria.