CommercialPrior AuthMedium impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Rheumatology, Gastroenterology +2 more·Pharmacy
Effective date
Dec 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota is implementing new prior authorization requirements for multiple specialty drugs and updating existing policies. New prior auth requirements begin December 1, 2025 for drugs like Imaavy, Emrelis, and several biosimilar denosumab products, while some policy revisions are already effective as of October 31, 2025.
Action Required
By December 1, 2025: Billing team must update prior authorization workflow for new specialty drugs including Nipocalimab-aahu (Imaavy), Telisotuzumab vedotin-tllv (Emrelis), and multiple denosumab biosimilars. Visit www.gatewaypa.com/policydisplay/52 to review complete Commercial policy requirements. Update billing system to flag these medications for prior auth verification before administration. Claims submitted without proper prior authorization will be denied.