MedicaidPrior AuthHigh impact
Pharmacy Policies Updates
Blue Cross Blue Shield of North Dakota·ND · Oncology, Hematology·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota has updated multiple pharmacy prior authorization policies for specialty medications, with new requirements effective October 1, 2025 for Datopotamab deruxtecan-dlnk (Datroway) and revised policies for various oncology drugs effective November 1, 2025. These changes affect prior authorization criteria, step therapy requirements, and billing codes for high-cost specialty medications.
Action Required
By October 1, 2025: Billing team must update prior authorization requirements for Datopotamab deruxtecan-dlnk (Datroway) in billing system for Medicaid Expansion patients. By November 1, 2025: Update prior authorization policies for Bevacizumab, Exagamglogene autotemcel, Inebilizumab-cdon, Naxitamab, PD-1/PD-L1 blocking antibodies, and Tafasitamab-cxix. Review gateway portal at www.gatewaypa.com/policydisplay/52 for complete Commercial policy updates. Update billing codes and ICD-10 mappings in system. Failure to obtain required prior authorizations will result in claim denials.