CommercialCoverageHigh impact
Medical Drug Preferred Product Updates for December 1, 2025
Blue Cross Blue Shield of North Dakota·ND · Rheumatology, Oncology, Ophthalmology +2 more·Pharmacy
Effective date
Dec 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSND is updating preferred drug lists for four medication categories effective December 1, 2025, which will affect prior authorization requirements and coverage tiers. Members with existing approvals for non-preferred products can continue until their approval expires, but new requests will need to use preferred agents first.
Action Required
Before December 1, 2025: Billing team must update prior authorization protocols to reflect new preferred drug lists for Infliximab, Rituximab, Beovu/Susvimo, and Denosumab. Review updated policies at http://www.gatewaypa/medicalpolicy/52 starting Dec 1st. For members wanting to switch from non-preferred to preferred products before approval expires, contact Prime Therapeutics Medical Pharmacy Solutions Team at 800-424-1708. Update encounter forms and EMR templates to reflect preferred agents to avoid coverage denials.