Nevada Medicaid Internal Clinical Decision and Reference Tool
Please use the search box below to look for the requested drug. You can search by drug name or NDC. Formulary status and any applicable restrictions or notes will display when you select the drug from the search results.
Review all "View Criteria" links for drug criteria, limits, and administrative notes.
Additional Tech Toolkit Resources:
e-Manual Updates & Announcements
Other Links:
NEVADA MEDICAID FEE-FOR-SERVICE MEDICAL BENEFIT PA Review Resources:
NEVADA MEDICAID FEE-FOR-SERVICE PHARMACY BENEFIT PA Review Resources:
NOTE: If a medication is listed on the SPDL, review must follow the SPDL drug OR drug-class criteria outlined in the MSM Chapter 1200 – Prescribed Drugs AND
- If medication is listed as non-preferred on the SPDL AND drug or drug-class specific criteria is NOT defined, member must meet Standard PDL Exception Criteria in the MSM Chapter 1200 document (Section 1203, Page 2-4).
- If the medication is listed as a non-preferred BRAND on the SPDL AND drug or drug-class criteria is NOT defined, member must meet the criteria outlined in the CareSource Medical Necessity for Multi-Source Brands Policy.
- If the medication has an SPDL Quantity or Age Limit and drug or drug-class criteria is NOT defined, member must meet the criteria outlined in the CareSource Medical Necessity - Off Label Policy.
- If the medication is NOT listed on the SPDL but criteria IS outlined in the MSM Chapter 1200 – Prescribed Drugs, member must meet that criteria as outlined.
- For medications NOT listed on the SPDL with NO criteria outlined in the MSM Chapter 1200 – Prescribed Drugs, these must be set up and sent to a clinical reviewer.
- Set up and send review per a) CareSource Drug or Drug Class Specific Pharmacy Criteria or Policy OR, if no drug OR drug-class OR indication specific policy, b) CareSource Medical Necessity for Non-Preferred Medications Administrative Policy.
CARESOURCE Pharmacy Benefit Resources: