MedicaidPrior AuthMedium impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·NV · Oncology, Ophthalmology, Hematology·Pharmacy
Effective date
Aug 5, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented new prior authorization requirements and quantity limits for several physician-administered drugs including cancer treatments, eye injection medications, and specialty infusions. These changes affect billing for drugs like Abraxane, bevacizumab, Darzalex, and anti-angiogenic eye agents.
Action Required
Immediately: Billing team must obtain prior authorization through https://www.mrxgateway.com/ before administering the following physician-administered drugs for Nevada Medicaid patients: Abraxane (paclitaxel albumin-bound), Anti-PD-1 monoclonal antibodies, Beovu, bevacizumab, Darzalex, Elaprase, and Anti-Angiogenic Ophthalmic Agents. Update billing workflow to check prior auth status before drug administration. Claims will be denied without proper authorization.