MedicaidPrior AuthMedium impact
Drug Utilization Review (DUR) Board approves changes effective July 6, 2026
Nevada Medicaid·NV · Pharmacy, Internal Medicine, Cardiology +3 more·Pharmacy
Effective date
Jul 6, 2026
We identified it
Jul 8, 2026
Summary
Nevada Medicaid updated its Drug Utilization Review (DUR) Point-of-Sale criteria effective July 6, 2026, adding new clinical criteria for 8 specialty pharmaceutical drugs across 6 drug classes: Aqvesme® (pyruvate kinase activator), Itvisma® (SMA agent), Exdensur® (respiratory biologic), Tryvio® (endothelin antagonist), Pivya® (antibiotic), and three transthyretin amyloidosis agents (Amvuttra®, Vyndamax®, Attruby®). Prior authorization requirements now apply to these medications.
Action Required
By July 6, 2026: Pharmacy and billing teams must obtain updated Prior Authorization forms from https://nv.primetherapeutics.com/provider/forms (pharmacy/point-of-sale section). Before dispensing or billing any of the eight specified drugs (Aqvesme®, Itvisma®, Exdensur®, Tryvio®, Pivya®, Amvuttra®, Vyndamax®, or Attruby®) for Nevada Medicaid members, verify and document that clinical criteria have been met. Update billing software and pharmacy systems to flag these drugs as requiring prior authorization. Communicate new requirements to prescribers and pharmacy staff. Claims submitted without meeting new clinical criteria may be denied by Nevada Medicaid.