CommercialPrior AuthHigh impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology, Neurology +1 more·Pharmacy
Effective date
Feb 10, 2026
We identified it
Jun 19, 2026
Summary
BCBS North Dakota is updating prior authorization policies for multiple oncology and specialty drugs effective February 10, 2026. Key changes include expanded coverage criteria for cancer treatments, new FDA-approved indications, updated diagnosis codes, and revised authorization procedures across 11 different drug policies.
Action Required
By February 10, 2026: Billing team must update prior authorization protocols for 11 specialty drugs including Bevacizumab, Briumvi, Columvi, Darzalex SQ, Epkinly, Gazyva, Kebilidi, Lemtrada, and Monjuvi. Update billing system with new ICD-10 codes and revised coverage criteria. Retire Infugem from formulary as manufacturer discontinued. Review current authorizations for affected patients and obtain new approvals under updated criteria. Claims submitted after effective date without proper authorization will be denied.