MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes effective June 30, 2025
Nevada Medicaid·NV · Pharmacy, Endocrinology, Pulmonology +2 more·Pharmacy
Effective date
Jun 30, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid updated its pharmacy prior authorization criteria effective June 30, 2025, adding several new drug categories and specific medications that now require prior authorization. Multiple new drug sections were created including Filsuvez, Juxtapid, Tryngolza, Yorvipath, Ocaliva, Iqirvo, and Livdelzi, while existing categories like Incretin Mimetics and Cystic Fibrosis Agents were expanded.
Action Required
Immediately: Billing team must update prior authorization workflows for Nevada Medicaid patients requiring the newly added medications (Ohtuvayre, Zepbound, Alyftrek, Filsuvez, Juxtapid, Tryngolza, Yorvipath, Ocaliva, Iqirvo, Livdelzi). Download updated prior authorization forms from https://nv.primetherapeutics.com/provider/forms and train staff on new requirements. Claims for these medications will be denied without proper prior authorization.