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Silver State Scripts Board Made Changes to the Preferred Drug List Effective November 1, 2026
Effective date
Nov 1, 2026
Identified
Nov 3, 2026
Summary
Silver State Scripts Board changed Nevada Medicaid's Preferred Drug List effective November 1, 2026, moving multiple drugs between preferred and non-preferred status, adding prior authorization requirements to some agents, and removing discontinued products. The billing team must track which drugs patients are prescribed, obtain prior authorizations where newly required, and expect claim denials for non-preferred drugs or discontinued products without prior auth or member exception requests.
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What to do
Action · 7 steps
01Effective November 1, 2026.
02Billing team should review all active prescriptions and pending claims for the affected drug classes to identify which patients are receiving drugs that changed status on the PDL.
03For drugs moved to preferred with prior authorization (Macitentan, Ambrisentan, Tofacitinib IR/ER tablets, Fulphila), get prior authorization before processing claims; claims without prior auth will be denied.
04For drugs moved to non-preferred (Tofacitinib solution, Xeljanz IR tablet and solution, Milnacipran, Drizalma sprinkle capsule, Gabapentin ER, Filkri, Fylnetra, Nypozi, Rolvedon, Ryzneuta, Stimufend, Timolol generic, Zolymbus gel), inform providers that these now require prior authorization or will have reduced coverage; coordinate with prescribers and pharmacies on coverage options.
05For drugs removed from the PDL (Adcirca, Idacio, Cymbalta, Basaglar TempoPen, insulin degludec generic, Phospholine iodide, Betoptic, Betoptic S, Betagan, Ocupress, Timoptic, Timoptic-XE, Trusopt, Xelpros, Vascepa, Lovaza), stop billing these drugs for Nevada Medicaid patients; communicate with prescribers and front desk staff that alternatives must be selected and that patients who still request discontinued drugs should understand they may not be covered.
06Update charge entry and claim submission edits to route affected medications to the correct prior authorization workflow and to flag non-preferred drugs before claims are submitted.
07Watch for member denials and appeals related to prior authorization lapses or non-preferred drug usage, and resubmit claims with proper prior authorization documentation when available.
Original notice
Silver State Scripts Board Made Changes to the Preferred Drug List Effective November 1, 2026
medicaid.nv.gov · Always check the source before changing claims.