MedicaidPrior AuthHigh impact
Medicaid Services Manual Chapter 1200 Updated
Nevada Medicaid·NV · Allergy & Immunology, Dermatology, Endocrinology +3 more·Provider Announcement
Effective date
Apr 6, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid updated their Prescribed Drugs manual (Chapter 1200) with significant changes to prior authorization requirements and clinical criteria for multiple drug categories. Key changes include new PA requirements for topical immunomodulators, updated criteria for Spevigo formulations, added coverage for new drugs like Wegovy tablets and several hereditary angioedema agents, and removal of discontinued medications.
Action Required
By April 6, 2026: Billing team must update prior authorization workflows for affected drug categories including topical immunomodulators, Spevigo IV/subcutaneous formulations, Rhapsido, Tonmya, Wegovy tablets, and hereditary angioedema agents. Review the updated MSM Chapter 1200 at the Nevada Medicaid website to identify specific PA requirements for each drug category. Update billing system to flag these medications for prior authorization and train staff on new clinical criteria requirements including age, weight, and specialist consultation requirements for certain drugs.