MedicaidPrior AuthMedium impact
Attention Provider Types 33 (Durable Medical Equipment, Prosthetics, Orthotics and Disposable Medical Supplies [DMEPOS]) and 28 (Pharmacy): Specialty Formula for Medicaid Recipients
Nevada Medicaid·NV · Pharmacy, Pediatrics·Pharmacy
Effective date
Nov 7, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now requires prior authorization for specialty formulas for EPSDT-aged recipients through pharmacy (24-hour review) and DMEPOS providers (2-4 business day review). All DMEPOS orders must be linked to a documented face-to-face encounter within 6 months prior to the approved PA start date.
Action Required
Immediately: Nevada providers must obtain prior authorization for all specialty formulas for EPSDT-aged Medicaid recipients. Pharmacy providers submit requests through ePA portal or call 1-800-695-5526. DMEPOS providers must ensure all orders are tied to documented face-to-face encounters within 6 months of PA approval. Update billing workflows to account for 24-hour pharmacy review and 2-4 business day DMEPOS review times.