CommercialPrior AuthHigh impact
Pharmacy Policy
Blue Cross Blue Shield of North Dakota·ND·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 19, 2026
Summary
BCBS of North Dakota is implementing extensive pharmacy policy changes effective July 1, 2026, including new prior authorization requirements for three medical drugs (Avlayah, Kresladi, Loargys), updated prior auth for Denosumab and Alpha-1 proteinase inhibitors, and retirement of two retail pharmacy programs (LMWH/Arixtra and Northera).
Action Required
By July 1, 2026: Billing team must update prior authorization workflows for new drugs Avlayah, Kresladi, and Loargys. Update existing prior auth protocols for Denosumab and Alpha-1 proteinase inhibitors. Remove utilization management requirements for Low Molecular Weight Heparins, Arixtra, and Northera from retail pharmacy protocols. Review complete policy details at www.gatewaypa.com/policydisplay/52 and www.myprime.com/en/forms.html after July 1, 2026. Failure to obtain required prior authorizations will result in claim denials.