MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes effective March 31, 2025
Nevada Medicaid·NV · Pharmacy, Rheumatology, Neurology +4 more·Pharmacy
Effective date
Mar 31, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid's Drug Use Review Board approved updates to pharmacy point-of-sale criteria effective March 31, 2025, adding several new specialty drug categories and updating prior authorization requirements for existing medications. The changes include new sections for rare disease treatments and updated age requirements and indications for existing drugs like Benlysta and Ingrezza.
Action Required
By March 31, 2025: Billing and pharmacy teams must update prior authorization processes for the listed specialty medications including Benlysta, Voydeya, Agamree, Duvyzat, Ingrezza, Xolremdi, Cayston, and others. Review updated PA guidelines at https://nv.primetherapeutics.com/provider/forms and ensure staff are aware of new age requirements and expanded indications. Claims for these medications without proper prior authorization will be denied.