MedicaidPrior AuthHigh impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota·ND · Endocrinology, Rheumatology, Infectious Disease +6 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota has implemented extensive pharmacy policy updates effective January 1, 2026, including new prior authorization requirements for multiple drugs, revised quantity limits, updated approval durations, and changes to step therapy requirements across Medicaid Expansion and Commercial plans.
Action Required
By December 31, 2025: Review all patients on affected medications including Xiaflex, insulin pumps, Eydenzelt, Qivigy, Afrezza, Efgartigimod, Qfitlia, Vykat XR, and Zelsuvmi. Update prior authorization workflows in billing system to reflect new requirements. Train staff on revised quantity limits and step therapy requirements. Verify patient eligibility for ACA copay waivers for HIV PrEP agents including new Yeztugo criteria. Update encounter forms to prompt for new documentation requirements.