CommercialPrior AuthMedium impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology·Pharmacy
Effective date
Aug 11, 2026
We identified it
Jun 19, 2026
Summary
BCBS North Dakota updated multiple oncology drug prior authorization policies effective August 11, 2026, expanding coverage criteria for cancer treatments including Bevacizumab, Enhertu, and others. New diagnosis codes were added and some prescriber restrictions were removed.
Action Required
By August 11, 2026: Update billing system and encounter forms with new ICD-10 diagnosis codes for biliary tract cancers (C22.1, C24.0, C24.8, C24.9), inflammatory breast cancer (C50.A0-A2), and other oncology conditions. Review expanded prior authorization criteria for oncology drugs at www.gatewaypa.com/policydisplay/52. Remove specialist consultation requirements for Crysvita prescriptions.