MedicaidPrior AuthMedium impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology, Rheumatology +2 more·Pharmacy
Effective date
Oct 1, 2025
We identified it
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.
Action Required
By September 30, 2025: Billing team must update prior authorization workflows for new Commercial medical drug policies (Avgemsi, Bendamustine, Gammagard Liquid ERC, Lynozyfic, Scenesse) effective October 1st. Review revised authorization criteria and length of authorization periods for existing drugs like Adcetris, Berinert, Blineyto, and others effective October 3rd. Update billing system to reflect new ICD-10 codes C90.11, C90.21, C90.31 for Multiple Myeloma coverage. Reference www.gatewaypa.com/policydisplay/52 for complete policy details starting October 1st.