MedicaidPrior AuthMedium impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota·ND · Rheumatology, Gastroenterology, Oncology +4 more·Pharmacy
Effective date
Aug 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota is implementing multiple pharmacy policy updates with staggered effective dates from August 1 to October 1, 2025. The changes include new and revised prior authorization requirements for specialty medications affecting Medicaid Expansion and Commercial plans, plus new retail pharmacy utilization management programs.
Action Required
By August 1, 2025: Update prior authorization workflows for Medicaid Expansion patients requiring specialty biologics (Cimzia, Tremfya, Omvoh IV, Skyrizi IV, Ilumya, Entyvio, etc.). By August 29, 2025: Implement prior auth requirements for Commercial patients receiving specialty infusion medications (Keytruda, Opdivo, Tecentriq IV, etc.). By October 1, 2025: Add quantity limits and prior auth for retail pharmacy programs including Alhemo, Elmiron, Journavx, and urinary incontinence medications. Reference www.gatewaypa.com/policydisplay/52 for detailed policy requirements.