MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·NV · Oncology, Hematology·Pharmacy
Effective date
Mar 3, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid's Drug Use Review Board updated prior authorization criteria for two physician-administered drugs: Elaprase (idursulfase) had hierarchy corrections, and Zynlonta (loncastuximab tesirine-lpyl) had significant coverage criteria changes including expanded lymphoma indications and updated recertification requirements.
Action Required
By March 3, 2025: Billing team must review updated prior authorization forms at https://gatewaypa.com/ for Elaprase and Zynlonta. Update prior authorization requests to reflect new criteria for Zynlonta including expanded B-Cell Lymphoma coverage and new recertification requirements. Providers should note removal of sunlight exposure warnings for Zynlonta patient counseling.