MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·NV · Oncology, Hematology, Nephrology +1 more·Pharmacy
Effective date
Jan 6, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid updated prior authorization criteria for physician-administered drugs effective January 6, 2025, including changes to cancer immunotherapy drugs, anemia treatments, and immunosuppressants. The changes include new drug approvals, updated dosage limits, and revised recertification requirements.
Action Required
Immediately: Billing teams must review updated prior authorization forms at https://gatewaypa.com/ for physician-administered drugs. Update prior authorization workflows for Anti-PD-1 monoclonal antibodies (tislelizumab, Bavencio, Libtayo, Opdivo, Tecentriq), Aranesp, pegfilgrastim products, pemetrexed, and selective immunosuppressants (Soliris, Ultomiris). Verify new recertification criteria and dosage limits are followed to prevent claim denials.