MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes effective April 6, 2026
Nevada Medicaid·NV · Pharmacy, Neurology, Endocrinology +2 more·Pharmacy
Effective date
Apr 6, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid updated prior authorization criteria for multiple specialty drug classes including immunomodulators, respiratory biologics, hormone modifiers, hereditary angioedema agents, Duchenne muscular dystrophy agents, and created new criteria for neurokinin-3 receptor antagonists. These changes affect point-of-sale pharmacy criteria and require updated prior authorization forms.
Action Required
By April 6, 2026: Billing and pharmacy teams must review updated prior authorization criteria for affected drug classes on Nevada Medicaid's pharmacy webpage at https://nv.primetherapeutics.com/provider/forms. Update internal drug coverage lists and prior authorization workflows for Spevigo, Rhapsido, topical androgens, hereditary angioedema agents (Andembry, Dawnzera, Kalbitor, Berinert, Ekterly), Duchenne muscular dystrophy drugs (Exondys 51, Vyondys 53, Viltepso, Amondys 45, Elevidys), and new neurokinin-3 receptor antagonists (Lynkuet, Veozah). Claims may be denied without proper prior authorization.