MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes effective January 5, 2026
Nevada Medicaid·NV · Pharmacy, Neurology, Pulmonology +5 more·Pharmacy
Effective date
Jan 5, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid's Drug Use Review Board approved updates to pharmacy point-of-sale criteria effective January 5, 2026, adding new drug classes and updating prior authorization requirements for multiple medication categories including Alzheimer's drugs, respiratory/allergy biologics, and anti-migraine medications. These changes affect prior authorization forms and approval criteria for numerous specialty medications.
Action Required
Effective January 5, 2026: Pharmacy and billing teams must update prior authorization procedures for the affected drug classes including Niemann-Pick Disease Type C agents, Alzheimer's disease agents (Kisunla), respiratory/allergy biologics (Dupixent, Nemluvio, Ebglyss), anti-migraine medications (Zavzpret), and other specified medications. Review updated PA forms at https://nv.primetherapeutics.com/provider/forms and ensure staff are aware of new criteria to prevent claim delays or denials.