MedicaidPrior AuthHigh impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·NV · Oncology, Hematology, Allergy & Immunology +2 more·Pharmacy
Effective date
Sep 30, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented new prior authorization requirements and quantity limits for multiple physician-administered drugs across 8 drug classes, including immune globulins, oncology medications, and colony stimulating factors. Providers must now obtain prior authorization before administering these medications to Nevada Medicaid patients.
Action Required
Immediately: Billing team and providers must obtain prior authorization before administering any of the listed medications (immune globulins, Keytruda, Kadcyla, colony stimulating factors, pemetrexed, HER2 inhibitors, CD20 monoclonal antibodies, selective immunosuppressants, and Yervoy) to Nevada Medicaid patients. Access prior authorization forms at https://www.mrxgateway.com/ under medical pharmacy/physician administered drugs. Update EMR templates to include prior auth requirements for these drugs. Claims will likely be denied without proper prior authorization.