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Silver State Scripts Board Made Changes to the Preferred Drug List Effective August 1, 2026

Nevada Medicaid·NV · Pharmacy, Allergy & Immunology, Endocrinology +7 more·Pharmacy
Effective date
Aug 1, 2026
We identified it
Aug 1, 2026
Days to comply
0 days

Summary

Nevada Medicaid (Silver State Scripts Board) has updated its Preferred Drug List effective August 1, 2026, with significant changes affecting pharmacy coverage across multiple drug classes. Key changes include: moving several drugs from preferred to non-preferred status (requiring prior authorization or becoming non-covered), adding new preferred options with prior authorization requirements, removing discontinued products, and establishing three new drug classes (Prolia/Biosimilars, Xgeva/Biosimilars, and DMD Corticosteroids). Billing teams must immediately update systems to reflect coverage and prior authorization requirements to avoid claim denials.

Action Required

Before Aug 1, 2026
By July 31, 2026: Billing team must immediately update the pharmacy benefits management system and claims processing software to reflect all PDL changes. SPECIFIC ACTIONS: (1) Update formulary status for all affected medications listed in the policy across nine drug classes; (2) Configure system to require prior authorization for: Mounjaro, Ozempic tablet, Ticagrelor (generic Brilinta), Ebglyss, Nemluvio, Spinosad, Piperonyl butoxide/pyrethrins, Hadlima, Starjemza, Selarsdi, Taltz, Enoby (Prolia class), Xtrenbo (Xgeva class), and Emflaza tablet (DMD Corticosteroids); (3) Remove from PDL and deny coverage for all discontinued products: Proventil HFA, ProAir Digihaler, Zegalogue, Byetta, Bydureon BCise, Insulin aspart generic (Novolog), Insulin aspart/aspart protamine generic (Novolog 70/30), Qtern brand, Amitiza, Nix, Rid, Ulesfia, Siliq, and Lindane; (4) Move to non-preferred status: Ventolin HFA, Brilinta, Invokamet, Invokana, Dapagliflozin/saxagliptin, Movantik, Crotan, Pruradik, Adalimumab-adbm (all), Avtozma, Kevzara, Pyzchiva, Yesintek, Imuldosa, Ustekinumab-aauz, Otezla XR/XR initiation pack, Cosentyx, and all non-preferred Prolia/Xgeva biosimilars; (5) Update encounter forms and prior authorization templates used by clinical staff; (6) Notify providers in all departments of coverage changes. WHO: Billing team updates system; IT department implements software changes; clinical staff updates templates; practice leadership communicates with providers. WHERE: In pharmacy billing module, claims processing rules, formulary database, and all prior authorization workflows. CONSEQUENCES: Claims for non-covered discontinued medications will be denied; claims lacking required prior authorization will be denied; incorrect coding of preferred vs. non-preferred drugs will result in payment delays or denials.