CommercialBilling CodesHigh impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology, Rheumatology +4 more·Pharmacy
Effective date
Jul 14, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota updated multiple pharmacy policies effective July 14, 2026, including new HCPCS codes for biosimilar drugs, expanded coverage criteria for various medications, and updated prior authorization requirements. Key changes include new biosimilar codes for Denosumab, Aflibercept, and Long-Acting G-CSF products, plus coverage expansions for several cancer and specialty medications.
Action Required
By July 14, 2026: Billing team must update system with new HCPCS codes - Q5170 for Eydenzelt, Q5171 for Boncresa, Q5165 for Oziltus, Q5166 for Osvyrti/Jubereq, Q5167 for Enoby/Xtrenbo, and Q5169 for Armlupeg. Discontinue use of J3590 for these biosimilar products after July 1, 2026. Update prior authorization forms to reflect expanded coverage criteria for Cosentyx (now covers ankylosing spondylitis in patients 12+), Aflibercept (up to every 20 weeks dosing), and multiple oncology drugs. Review and update ICD-10 codes for Erbitux coverage, removing C00.0-C00.2 and adding C17.0-C17.9 and Z85.068.