MedicaidPrior AuthHigh impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·NV · Oncology, Hematology, Ophthalmology +5 more·Pharmacy
Effective date
Jan 5, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid's Drug Use Review Board approved extensive updates to prior authorization criteria for physician-administered drugs, affecting multiple drug classes including cancer treatments, immune globulins, and ophthalmic agents. The changes update universal criteria, dosing limits, recertification requirements, and prior authorization guidelines across numerous medications effective January 5, 2026.
Action Required
Immediately: Billing team must review and update prior authorization workflows for all physician-administered drugs listed in the policy. Access updated PA forms at https://gatewaypa.com/ under medical pharmacy/physician administered drugs section. Update billing system rules to reflect new universal criteria, dosing limits, and recertification requirements for affected medications. Failure to follow new PA guidelines will result in claim denials for Nevada Medicaid patients.