MedicaidPrior AuthHigh impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·NV · Oncology, Ophthalmology, Hematology·Pharmacy
Effective date
Aug 4, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has updated prior authorization criteria for 15 physician administered drug classes including chemotherapy drugs, eye injections, and specialty medications. The changes affect common oncology and ophthalmology drugs like Abraxane, Eylea, Avastin, and others.
Action Required
By August 4, 2025: Billing team must review updated prior authorization requirements for physician administered drugs at https://gatewaypa.com/ (medical pharmacy/physician administered drugs). Update billing workflows to ensure prior authorization is obtained for affected drugs including Abraxane, Eylea, Avastin, Darzalex, and others listed. Claims without proper prior authorization will be denied.