MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·NV · Oncology, Ophthalmology, Hematology +1 more·Pharmacy
Effective date
Mar 31, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid's Drug Use Review Board updated coverage criteria for multiple physician-administered drugs including cancer immunotherapies, ophthalmic agents, and other specialty medications. Changes include new covered indications, updated dosage limits, and modified prior authorization requirements for drugs like Opdivo, Keytruda, Tecentriq, and others.
Action Required
By March 31, 2025: Billing team must review and update prior authorization protocols for physician-administered drugs listed in the policy. Access updated PA forms at https://gatewaypa.com/ (medical pharmacy/physician administered drugs section). Update billing system notes to reflect new coverage criteria for cancer treatments, ophthalmic injections, and specialty medications. Verify PA requirements before administering affected drugs to Nevada Medicaid patients.