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Pharmacy Policy Updates
Act
by Sep 30, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota updated multiple pharmacy policies effective October 1-3, 2025, including new prior authorization requirements for several medications and revised authorization criteria for existing drugs. The changes affect both Medicaid Expansion and Commercial plans with specific updates to oncology, immunology, and specialty drug policies.
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What to do
by Sep 30, 2025 · 4 steps
01Billing team must update prior authorization workflows for new Commercial medical drug policies (Avgemsi, Bendamustine, Gammagard Liquid ERC, Lynozyfic, Scenesse) effective October 1st.
02Review revised authorization criteria and length of authorization periods for existing drugs like Adcetris, Berinert, Blineyto, and others effective October 3rd.
03Update billing system to reflect new ICD-10 codes C90.11, C90.21, C90.31 for Multiple Myeloma coverage.
04Reference www.gatewaypa.com/policydisplay/52 for complete policy details starting October 1st.
Codes mentioned
C90.11C90.21C90.31J7321
Original notice
Pharmacy Policy Updates
bcbsnd.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of North Dakota changes →Pharmacy Policy UpdatesHighEffective Jul 14, 2026 · PharmacyPharmacy Policies Available OnlineMediumNo effective date · PharmacyPharmacy Policies Available OnlineHighEffective Oct 1, 2026 · PharmacyPharmacy Policies Available OnlineMediumEffective Nov 1, 2026 · PharmacyBrowse every Blue Cross Blue Shield of North Dakota change in the policy list