Nevada Senate Bill SB161 Enrolled / Bill

                     
- 	82nd Session (2023) 
Senate Bill No. 161–Senators Scheible, D. Harris, Spearman, 
Cannizzaro, Seevers Gansert; Daly, Donate, Dondero Loop, 
Flores, Goicoechea, Hansen, Krasner, Neal, Nguyen, 
Ohrenschall, Pazina and Stone 
 
CHAPTER.......... 
 
AN ACT relating to personal health; expanding required insurance 
coverage of contraception; providing for the use of benefits 
under certain federal programs for persons with low incomes 
to purchase menstrual products; authorizing the establishment 
of a program to assist certain recipients of public assistance 
in the purchase of menstrual products; authorizing certain 
persons and entities to acquire controlled substances and 
dangerous drugs directly from an outsourcing facility; 
revising requirements governing the dispensing of a drug 
used for contraception; enacting the Interstate Massage 
Compact; increasing the number of members of the Board of 
Massage Therapy required to constitute a quorum for the 
purposes of transacting the business of the Board; clarifying 
that a pharmacy benefit manager is subject to certain 
provisions of law governing an insurer for which the 
pharmacy benefit manager manages prescription drug 
coverage; and providing other matters properly relating 
thereto. 
Legislative Counsel’s Digest: 
 Existing law requires public and private policies of insurance regulated under 
Nevada law to include coverage for up to a 12-month supply of contraceptive 
drugs. (NRS 287.010, 287.04335, 422.27172, 689A.0418, 689B.0378, 689C.1676, 
695A.1865, 695B.1919, 695C.1696, 695G.1715) Sections 1, 11 and 14-20 of this 
bill prohibit an insurer from requiring an insured to obtain prior authorization 
before receiving a contraceptive drug. Sections 1 and 14-20 also require an insurer 
to: (1) cover certain contraceptive services when provided by a pharmacist to the 
same extent as if the services were provided by another provider of health care in 
certain circumstances; and (2) reimburse a pharmacist for providing such services 
at a rate that is not less than the rate provided to a physician, physician assistant or 
advanced practice registered nurse. Sections 1 and 14-20 additionally prescribe 
certain limitations on the imposition of a copayment or coinsurance for a drug for 
contraception. Section 10 of this bill requires an insurer to: (1) demonstrate the 
capacity to adequately deliver family planning services provided by pharmacists to 
covered persons; and (2) make available to covered persons a notice of pharmacists 
and pharmacies that are available to provide family planning services to covered 
persons through the network of the insurer. Sections 12 and 13 of this bill make 
conforming changes to indicate the proper placement of section 10 in the Nevada 
Revised Statutes. 
 Existing law imposes certain duties on a pharmacy benefit manager. (NRS 
683A.178) Section 9 of this bill clarifies that a pharmacy benefit manager that 
manages prescription drug benefits for an insurer is required to comply with the 
same provisions of the Nevada Insurance Code as are applicable to the insurer.   
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 Existing law authorizes the Department of Health and Human Services to enter 
into a contract with a pharmacy benefit manager or a health maintenance 
organization to manage, direct and coordinate all payments and rebates for 
prescription drugs and all other services and payments relating to the provision of 
prescription drugs under the State Plan for Medicaid and the Children’s Health 
Insurance Program. (NRS 422.4053) Section 2 of this bill requires such a contract 
to require the pharmacy benefit manager or health maintenance organization to 
comply with certain provisions of law regarding the provision of prescription drugs 
under the State Plan for Medicaid and the Children’s Health Insurance Program. 
 Existing federal law establishes the Supplemental Nutrition Assistance 
Program, which provides assistance to certain low-income families for the purchase 
of food. (7 U.S.C. §§ 2011 et seq.) Existing federal law also establishes the Special 
Supplemental Nutrition Program for Women, Infants and Children, which provides, 
through eligible local agencies, nutrition education and supplemental foods to 
pregnant women, mothers, infants and children less than 5 years of age with low 
household incomes. (42 U.S.C. § 1786) Existing law requires the Department of 
Health and Human Services to administer these programs within this State. (NRS 
422A.338) Section 3 of this bill requires the Department to authorize recipients of 
benefits provided under those programs to use such benefits to purchase menstrual 
products: (1) to the extent authorized by federal law; and (2) to the extent that 
federal funding is available. This bill also authorizes the Department to: (1) 
establish and administer a program to provide assistance for the purpose of 
purchasing menstrual products to recipients of benefits provided through programs 
for which the Division of Welfare and Supportive Services of the Department is 
responsible; and (2) accept gifts, grants and donations for the purposes of 
establishing such a program. 
 Existing law imposes certain requirements governing the purchase and sale of 
controlled substances and dangerous drugs. (NRS 639.268) Existing regulations 
prescribe certain requirements concerning the operation of outsourcing facilities, 
which are federally registered facilities that engage in the compounding of drugs. 
(NAC 639.691-639.6916) Those requirements include requirements that an 
outsourcing facility: (1) be licensed by the State Board of Pharmacy as a 
manufacturer; and (2) comply with regulatory requirements governing 
manufacturers. (NAC 639.6915) Section 5 of this bill authorizes a person or entity 
authorized to dispense controlled substances and dangerous drugs to purchase or 
otherwise acquire controlled substances and dangerous drugs compounded or 
repackaged by an outsourcing facility directly from the outsourcing facility. 
Section 4 of this bill makes a conforming change to update an internal reference 
changed by section 5. 
 Existing law requires a pharmacist to dispense up to a 12-month supply of 
contraceptives or therapeutic equivalent or any amount which covers the remainder 
of the plan year, whichever is less, pursuant to a valid prescription or order if: (1) 
the patient has previously received a 3-month supply of the same drug; (2) the 
patient has previously received a 9-month supply of the same drug or a supply of 
the same drug for the balance of the plan year in which the 3-month supply was 
prescribed or ordered, whichever is less; (3) the patient is insured by the same 
health insurance plan; and (4) a provider of health care has not specified in the 
prescription or order that a different supply of the drug is necessary. (NRS 
639.28075) If a patient is not currently using a contraceptive or therapeutic 
equivalent, section 6 of this bill requires a pharmacist to dispense a full 3-month 
supply or the amount designated by the prescription or order, whichever is less, 
pursuant to a valid prescription or order unless the patient is unable or unwilling to 
pay the applicable charge, copayment or coinsurance. If the patient is currently   
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- 	82nd Session (2023) 
using the contraceptive or therapeutic equivalent, section 6 requires a pharmacist to 
dispense a full 9-month supply or a full 12-month supply, as applicable, any 
amount designated by the prescription or order or any amount which covers the 
remainder of the plan year, whichever is less, pursuant to a valid prescription or 
order unless the patient is unable or unwilling to pay the applicable charge, 
copayment or coinsurance. 
 Existing law authorizes the Board of Massage Therapy to issue a license to 
practice massage therapy and sets forth the requirements that an applicant for a 
license must satisfy in order to become licensed. (NRS 640C.580) Section 7 of this 
bill adopts the Interstate Massage Compact, creating a multistate license with 
uniform licensing requirements, including a national licensing examination, for use 
by licensees in all member states.  
 The Compact requires that, in order to be eligible to join the Compact and 
maintain eligibility as a member state, a state must: (1) license and regulate the 
practice of massage therapy; (2) have a mechanism or entity in place to receive and 
investigate complaints from the public, regulatory or law enforcement agencies or 
the Interstate Massage Compact Commission about licensees practicing in that 
state; (3) accept passage of a national licensing examination as a criterion for 
massage therapy licensure in that state; (4) require that licensees satisfy educational 
requirements before being licensed; (5) implement procedures for requiring 
background checks for a multistate license and other reporting requirements; (6) 
have continuing competence requirements; (7) participate in the Compact’s data 
system; (8) notify the Commission and other member states of any disciplinary 
action taken against a licensee practicing under a multistate license; (9) comply 
with any rules of the Commission; and (10) accept licensees with valid multistate 
licenses from other member states. An applicant for a multistate license must: (1) 
hold a license to practice massage therapy in a member state; (2) complete 625 
hours of massage therapy education or the substantial equivalent; (3) pass a 
national licensing examination or the substantial equivalent; (4) submit to and pass 
a background check; and (5) pay all required fees.  
 The Compact: (1) establishes the Interstate Massage Compact Commission as a 
joint governmental agency whose membership consists of all member states; and 
(2) provides for the Commission’s rules and governance. The Compact also 
establishes a data system, provided for by the Commission, and requires member 
states to submit uniform data to the data system on all individuals to whom the 
Compact is applicable. 
 The Compact provides additional provisions to carry out the Compact, 
including providing procedures for the taking of adverse actions against licensees, 
provisions for active military members or their spouses, provisions for rulemaking 
by the Commission, provisions for oversight and dispute resolution and procedures 
for amendments and withdrawals. The Compact takes effect on the date on which 
the Compact is enacted into law by the seventh member state.  
 Existing law provides that four members of the Board of Massage Therapy 
constitute a quorum for the purposes of transacting the business of the Board. (NRS 
640C.180) Section 8 of this bill increases the number of board members needed to 
constitute a quorum from four to five. 
 
 
 
 
 
 
   
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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. 
 
 
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN 
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: 
 
 Section 1.  NRS 422.27172 is hereby amended to read as 
follows: 
 422.27172 1. The Director shall include in the State Plan for 
Medicaid a requirement that the State pay the nonfederal share of 
expenditures incurred for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is lawfully 
prescribed or ordered and which has been approved by the Food and 
Drug Administration; 
 (c) Self-administered hormonal contraceptives dispensed by a 
pharmacist pursuant to NRS 639.28078; 
 (d) Insertion or removal of a device for contraception; 
 (e) Education and counseling relating to the initiation of the use 
of contraceptives and any necessary follow-up after initiating such 
use; 
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2.  Except as otherwise provided in subsections 4 and 5, to 
obtain any benefit provided in the Plan pursuant to subsection 1, a 
person enrolled in Medicaid must not be required to: 
 (a) Pay a higher deductible, any copayment or coinsurance; or 
 (b) Be subject to a longer waiting period or any other condition. 
 3. The Director shall ensure that the provisions of this section 
are carried out in a manner which complies with the requirements 
established by the Drug Use Review Board and set forth in the list 
of preferred prescription drugs established by the Department 
pursuant to NRS 422.4025. 
 4. The Plan may require a person enrolled in Medicaid to pay a 
higher deductible, copayment or coinsurance for a drug for 
contraception if the person refuses to accept a therapeutic equivalent 
of the contraceptive drug. 
 5. For each method of contraception which is approved by the 
Food and Drug Administration, the Plan must include at least one 
contraceptive drug or device for which no deductible, copayment or   
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coinsurance may be charged to the person enrolled in Medicaid, but 
the Plan may charge a deductible, copayment or coinsurance for any 
other contraceptive drug or device that provides the same method of 
contraception. If the Plan requires a person enrolled in Medicaid 
to pay a copayment or coinsurance for a drug for contraception, 
the Plan may only require the person to pay the copayment or 
coinsurance: 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed. 
 6.  The Plan must provide for the reimbursement of a 
pharmacist for providing services described in subsection 1 that 
are within the scope of practice of the pharmacist to the same 
extent as if the services were provided by another provider of 
health care. The Plan must not limit: 
 (a) Coverage for such services provided by a pharmacist to a 
number of occasions less than the coverage for such services when 
provided by another provider of health care. 
 (b) Reimbursement for such services provided by a pharmacist 
to an amount less than the amount reimbursed for similar services 
provided by a physician, physician assistant or advanced practice 
registered nurse. 
 7. The Plan must not require a recipient of Medicaid to 
obtain prior authorization for the benefits described in paragraphs 
(a) and (c) of subsection 1. 
 8. As used in this section: 
 (a) “Drug Use Review Board” has the meaning ascribed to it in 
NRS 422.402. 
 (b) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 (c) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 2.  NRS 422.4053 is hereby amended to read as follows: 
 422.4053 1. Except as otherwise provided in subsection 2, 
the Department shall directly manage, direct and coordinate all 
payments and rebates for prescription drugs and all other services   
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and payments relating to the provision of prescription drugs under 
the State Plan for Medicaid and the Children’s Health Insurance 
Program. 
 2. The Department may enter into a contract with: 
 (a) A pharmacy benefit manager for the provision of any 
services described in subsection 1. 
 (b) A health maintenance organization pursuant to NRS 422.273 
for the provision of any of the services described in subsection 1 for 
recipients of Medicaid or recipients of insurance through the 
Children’s Health Insurance Program who receive coverage through 
a Medicaid managed care program. 
 (c) One or more public or private entities from this State, the 
District of Columbia or other states or territories of the United States 
for the collaborative purchasing of prescription drugs in accordance 
with subsection 3 of NRS 277.110.  
 3.  A contract entered into pursuant to paragraph (a) or (b) of 
subsection 2 must: 
 (a) Include the provisions required by NRS 422.4056; [and] 
 (b) Require the pharmacy benefit manager or health 
maintenance organization, as applicable, to disclose to the 
Department any information relating to the services covered by the 
contract, including, without limitation, information concerning 
dispensing fees, measures for the control of costs, rebates collected 
and paid and any fees and charges imposed by the pharmacy benefit 
manager or health maintenance organization pursuant to the contract 
[.] ; and 
 (c) Require the pharmacy benefit manager or health 
maintenance organization to comply with the provisions of this 
chapter regarding the provision of prescription drugs under the 
State Plan for Medicaid and the Children’s Health Insurance 
Program to the same extent as the Department. 
 4. In addition to meeting the requirements of subsection 3, a 
contract entered into pursuant to: 
 (a) Paragraph (a) of subsection 2 may require the pharmacy 
benefit manager to provide the entire amount of any rebates 
received for the purchase of prescription drugs, including, without 
limitation, rebates for the purchase of prescription drugs by an entity 
other than the Department, to the Department. 
 (b) Paragraph (b) of subsection 2 must require the health 
maintenance organization to provide to the Department the entire 
amount of any rebates received for the purchase of prescription 
drugs, including, without limitation, rebates for the purchase of 
prescription drugs by an entity other than the Department, less an   
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administrative fee in an amount prescribed by the contract. The 
Department shall adopt policies prescribing the maximum amount 
of such an administrative fee. 
 Sec. 3.  Chapter 422A of NRS is hereby amended by adding 
thereto a new section to read as follows: 
 1. To the extent authorized by federal law and to the extent 
that federal funding is available, the Department shall authorize 
recipients of benefits provided under Supplemental Nutrition 
Assistance or the Special Supplemental Nutrition Program for 
Women, Infants and Children established by 42 U.S.C. § 1786 to 
use such benefits to purchase menstrual products.  
 2. The Department shall take any action necessary to obtain 
federal authorization and federal funding to carry out the 
provisions of subsection 1, including, without limitation, applying 
for any necessary federal waiver. 
 3. To the extent that money is available for this purpose, the 
Department, through the Division, may establish and administer a 
program to provide assistance for the purpose of purchasing 
menstrual products to recipients of benefits provided through 
programs for which the Division is responsible. The Department 
may accept gifts, grants and donations from any source for the 
purpose of establishing and administering such a program. 
 4. As used in this section, “menstrual products” includes, 
without limitation, sanitary napkins, tampons or similar products 
used in connection with the menstrual cycle. 
 Sec. 4.  NRS 454.221 is hereby amended to read as follows: 
 454.221 1.  A person who furnishes any dangerous drug 
except upon the prescription of a practitioner is guilty of a category 
D felony and shall be punished as provided in NRS 193.130, unless 
the dangerous drug was obtained originally by a legal prescription. 
 2.  The provisions of this section do not apply to the furnishing 
of any dangerous drug by: 
 (a) A practitioner to his or her patients; 
 (b) A physician assistant licensed pursuant to chapter 630 or 633 
of NRS if authorized by the Board; 
 (c) A registered nurse while participating in a public health 
program approved by the Board, or an advanced practice registered 
nurse who holds a certificate from the State Board of Pharmacy 
permitting him or her to dispense dangerous drugs; 
 (d) A manufacturer or wholesaler or pharmacy to each other or 
to a practitioner or to a laboratory under records of sales and 
purchases that correctly give the date, the names and addresses of 
the supplier and the buyer, the drug and its quantity;   
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 (e) A hospital pharmacy or a pharmacy so designated by a 
county health officer in a county whose population is 100,000 or 
more, or by a district health officer in any county within its 
jurisdiction or, in the absence of either, by the Chief Medical Officer 
or the Chief Medical Officer’s designated Medical Director of 
Emergency Medical Services, to a person or agency described in 
subsection [3] 4 of NRS 639.268 to stock ambulances or other 
authorized vehicles or replenish the stock; or 
 (f) A pharmacy in a correctional institution to a person 
designated by the Director of the Department of Corrections to 
administer a lethal injection to a person who has been sentenced to 
death. 
 Sec. 5.  NRS 639.268 is hereby amended to read as follows: 
 639.268 1.  A practitioner may purchase supplies of 
controlled substances, poisons, dangerous drugs and devices from a 
pharmacy by: 
 (a) Making an oral order to the pharmacy or transmitting an oral 
order through his or her agent, except an order for a controlled 
substance in schedule II; or 
 (b) If the order is for a controlled substance, presenting to the 
pharmacy a written order signed by the practitioner which contains 
his or her registration number issued by the Drug Enforcement 
Administration. 
 2.  Any person or entity authorized to dispense controlled 
substances and dangerous drugs, including, without limitation, a 
pharmacy, institutional pharmacy or practitioner, may: 
 (a) Purchase or otherwise acquire controlled substances and 
dangerous drugs compounded or repackaged by an outsourcing 
facility directly from the outsourcing facility without an order 
from a practitioner other than, where applicable, the practitioner 
purchasing or acquiring the controlled substance or dangerous 
drug; and 
 (b) Administer and dispense controlled substances and 
dangerous drugs purchased or acquired pursuant to paragraph (a) 
to the same extent as controlled substances and dangerous drugs 
acquired through other authorized means. 
 3. A hospital pharmacy or a pharmacy designated for this 
purpose by a county health officer in a county whose population is 
100,000 or more, or by a district health officer in any county within 
its jurisdiction or, in the absence of either, by the Chief Medical 
Officer or his or her designated medical director of emergency 
medical services, may sell to a person or agency described in 
subsection [3] 4 supplies of controlled substances to stock the   
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ambulances or other authorized vehicles of such a person or agency 
or replenish the stock if: 
 (a) The person or agency is registered with the Drug 
Enforcement Administration pursuant to 21 C.F.R. Part 1301; 
 (b) The person in charge of the controlled substances is: 
  (1) A paramedic appropriately certified by the health 
authority; 
  (2) A registered nurse licensed by the State Board of 
Nursing; or 
  (3) A person who holds equivalent certification or licensure 
issued by another state; and 
 (c) Except as otherwise provided in this paragraph, the purchase 
order is countersigned by a physician or initiated by an oral order 
and may be made by the person or agency or transmitted by an agent 
of such a person or agency. An order for a controlled substance 
listed in schedule II must be made pursuant to NRS 453.251. 
 [3.] 4.  A pharmacy, institutional pharmacy or other person 
licensed by the Board to furnish controlled substances and 
dangerous drugs may sell to: 
 (a) The holder of a permit issued pursuant to the provisions of 
NRS 450B.200 or 450B.210; 
 (b) The holder of a permit issued by another state which is 
substantially similar to a permit issued pursuant to the provisions of 
NRS 450B.200 or 450B.210; and 
 (c) An agency of the Federal Government that provides 
emergency care or transportation and is registered with the Drug 
Enforcement Administration pursuant to 21 C.F.R. Part 1301. 
 [4.] 5.  A pharmacy, institutional pharmacy , outsourcing 
facility or other person licensed by the Board to furnish dangerous 
drugs who sells supplies pursuant to this section shall maintain a 
record of each sale which must contain: 
 (a) The date of sale; 
 (b) The name, address and signature of the purchaser or the 
person receiving the delivery; 
 (c) The name of the dispensing pharmacist [;] , where 
applicable; 
 (d) The name and address of the authorizing practitioner [;] , 
where applicable; and 
 (e) The name, strength and quantity of each drug sold. 
 [5.] 6.  A pharmacy, institutional pharmacy or other person 
licensed by the Board to furnish dangerous drugs who supplies the 
initial stock for an ambulance or other emergency vehicle shall   
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comply with any applicable regulations adopted by the State Board 
of Health, or a district board of health, pursuant to NRS 450B.120. 
 [6.] 7.  The Board shall adopt regulations regarding the records 
a pharmacist shall keep of any purchase made pursuant to this 
section. 
 8. As used in this section: 
 (a) “Compounding” includes, without limitation, the 
combining, admixing, mixing, pooling, reconstituting or other 
altering of a drug or bulk drug substance, as defined in 21 C.F.R. 
§ 207.3, to create a drug. 
 (b) “Outsourcing facility” means a manufacturer at one 
geographic location or address that: 
  (1) Is engaged in the compounding of sterile or nonsterile 
drugs for use by humans; and  
  (2) Has registered with the Secretary of Health and Human 
Services as an outsourcing facility pursuant to 21 U.S.C. § 353b. 
 Sec. 6.  NRS 639.28075 is hereby amended to read as follows: 
 639.28075 1. Except as otherwise provided in [subsections] 
subsection 2 , [and 3,] pursuant to a valid prescription or order for a 
drug to be used for contraception or its therapeutic equivalent which 
has been approved by the Food and Drug Administration , a 
pharmacist shall: 
 (a) [The first time dispensing the drug or therapeutic equivalent 
to] If the patient [,] is not currently using the drug or its 
therapeutic equivalent, dispense up to a 3-month supply of the drug 
or therapeutic equivalent [.] or any amount designated by the 
prescription or order, whichever is less. 
 (b) [The second time dispensing] If the drug or therapeutic 
equivalent has only been dispensed to the patient [,] once pursuant 
to paragraph (a), dispense up to a 9-month supply of the drug or 
therapeutic equivalent, any amount designated by the prescription 
or order or any amount which covers the remainder of the plan year 
if the patient is covered by a health care plan, whichever is less. 
 (c) For a refill in a plan year following the initial dispensing of a 
drug or therapeutic equivalent pursuant to paragraphs (a) and (b), 
dispense [up to] a 12-month supply of the drug or therapeutic 
equivalent , any amount designated by the prescription or order or 
any amount which covers the remainder of the plan year if the 
patient is covered by a health care plan, whichever is less. 
 2. [The provisions of paragraphs (b) and (c) of subsection 1 
only apply if: 
 (a) The drug for contraception or the therapeutic equivalent of 
such drug is the same drug or therapeutic equivalent which was   
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previously prescribed or ordered pursuant to paragraph (a) of 
subsection 1; and 
 (b) The patient is covered by the same health care plan. 
 3. If a prescription or order for a drug for contraception or its 
therapeutic equivalent limits the dispensing of the drug or 
therapeutic equivalent to a quantity which is less than the amount 
otherwise authorized to be dispensed pursuant to subsection 1, the 
pharmacist must dispense the drug or therapeutic equivalent in 
accordance with the quantity specified in the prescription or order. 
 4.] A pharmacist is not required to dispense an amount of a 
drug to be used for contraception or its therapeutic equivalent for 
which the patient is unable or unwilling to pay any applicable 
charge, copayment or coinsurance due to the pharmacy. 
 3. As used in this section: 
 (a) “Health care plan” means a policy, contract, certificate or 
agreement offered or issued by an insurer, including without 
limitation, the State Plan for Medicaid, to provide, deliver, arrange 
for, pay for or reimburse any of the costs of health care services. 
 (b) “Plan year” means the year designated in the evidence of 
coverage of a health care plan in which a person is covered by such 
plan. 
 (c) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 7.  Chapter 640C of NRS is hereby amended by adding 
thereto a new section to read as follows: 
 
INTERSTATE MASSAGE COMPACT 
ARTICLE 1-PURPOSE 
 
 The purpose of this Compact is to reduce the burdens on State 
governments and to facilitate the interstate practice and regulation 
of Massage Therapy with the goal of improving public access to, 
and the safety of, Massage Therapy Services. Through this 
Compact, the Member States seek to establish a regulatory 
framework which provides for a new multistate licensing program. 
Through this additional licensing pathway, the Member States   
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seek to provide increased value and mobility to licensed massage 
therapists in the Member States, while ensuring the provision of 
safe, competent, and reliable services to the public.  
 This Compact is designed to achieve the following objectives, 
and the Member States hereby ratify the same intentions by 
subscribing hereto: 
 A. Increase public access to Massage Therapy Services by 
providing for a multistate licensing pathway; 
 B. Enhance the Member States’ ability to protect the public’s 
health and safety; 
 C. Enhance the Member States’ ability to prevent human 
trafficking and licensure fraud; 
 D. Encourage the cooperation of Member States in 
regulating the multistate Practice of Massage Therapy; 
 E. Support relocating military members and their spouses; 
 F. Facilitate and enhance the exchange of licensure, 
investigative, and disciplinary information between the Member 
States; 
 G. Create an Interstate Commission that will exist to 
implement and administer the Compact;  
 H. Allow a Member State to hold a Licensee accountable, 
even where that Licensee holds a Multistate License; 
 I. Create a streamlined pathway for Licensees to practice in 
Member States, thus increasing the mobility of duly licensed 
massage therapists; and 
 J. Serve the needs of licensed massage therapists and the 
public receiving their services; however,  
 K. Nothing in this Compact is intended to prevent a State 
from enforcing its own laws regarding the Practice of Massage 
Therapy. 
 
ARTICLE 2-DEFINITIONS 
 
 As used in this Compact, except as otherwise provided and 
subject to clarification by the Rules of the Commission, the 
following definitions shall govern the terms herein: 
 A. “Active Military Member” - any person with full-time duty 
status in the armed forces of the United States, including members 
of the National Guard and Reserve. 
 B. “Adverse Action” - any administrative, civil, equitable, or 
criminal action permitted by a Member State’s laws which is 
imposed by a Licensing Authority or other regulatory body against 
a Licensee, including actions against an individual’s   
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Authorization to Practice such as revocation, suspension, 
probation, surrender in lieu of discipline, monitoring of the 
Licensee, limitation of the Licensee’s practice, or any other 
Encumbrance on licensure affecting an individual’s ability to 
practice Massage Therapy, including the issuance of a cease and 
desist order. 
 C. “Alternative Program” - a non-disciplinary monitoring or 
prosecutorial diversion program approved by a Member State’s 
Licensing Authority. 
 D. “Authorization to Practice” - a legal authorization by a 
Remote State pursuant to a Multistate License permitting the 
Practice of Massage Therapy in that Remote State, which shall be 
subject to the enforcement jurisdiction of the Licensing Authority 
in that Remote State. 
 E. “Background Check” - the submission of an applicant’s 
criminal history record information, as further defined in 28 
C.F.R. § 20.3(d), as amended from the Federal Bureau of 
Investigation and the agency responsible for retaining State 
criminal records in the applicant’s Home State. 
 F. “Charter Member States” - Member States who have 
enacted legislation to adopt this Compact where such legislation 
predates the effective date of this Compact as defined in Article 12. 
 G. “Commission” - the government agency whose 
membership consists of all States that have enacted this Compact, 
which is known as the Interstate Massage Compact Commission, 
as defined in Article 8, and which shall operate as an 
instrumentality of the Member States. 
 H. “Continuing Competence” - a requirement, as a condition 
of license renewal, to provide evidence of participation in, and 
completion of, educational or professional activities that maintain, 
improve, or enhance Massage Therapy fitness to practice. 
 I. “Current Significant Investigative Information” - 
Investigative Information that a Licensing Authority, after an 
inquiry or investigation that complies with a Member State’s due 
process requirements, has reason to believe is not groundless and, 
if proved true, would indicate a violation of that State’s laws 
regarding the Practice of Massage Therapy. 
 J. “Data System” - a repository of information about 
Licensees who hold Multistate Licenses, which may include but is 
not limited to license status, Investigative Information, and 
Adverse Actions.   
 	– 14 – 
 
 
- 	82nd Session (2023) 
 K. “Disqualifying Event” - any event which shall disqualify 
an individual from holding a Multistate License under this 
Compact, which the Commission may by Rule specify. 
 L. “Encumbrance” - a revocation or suspension of, or any 
limitation or condition on, the full and unrestricted Practice of 
Massage Therapy by a Licensing Authority. 
 M. “Executive Committee” - a group of delegates elected or 
appointed to act on behalf of, and within the powers granted to 
them by, the Commission. 
 N. “Home State” - means the Member State which is a 
Licensee’s primary state of residence where the Licensee holds an 
active Single-State License. 
 O. “Investigative Information” - information, records, or 
documents received or generated by a Licensing Authority 
pursuant to an investigation or other inquiry. 
 P. “Licensing Authority” - a State’s regulatory body 
responsible for issuing Massage Therapy licenses or otherwise 
overseeing the Practice of Massage Therapy in that State. 
 Q. “Licensee” - an individual who currently holds a license 
from a Member State to fully practice Massage Therapy, whose 
license is not a student, provisional, temporary, inactive, or other 
similar status. 
 R. “Massage Therapy”, “Massage Therapy Services”, and 
the “Practice of Massage Therapy” - the care and services 
provided by a Licensee as set forth in the Member State’s statutes 
and regulations in the State where the services are being provided. 
 S. “Member State” - any State that has adopted this Compact. 
 T. “Multistate License” - a license that consists of 
Authorizations to Practice Massage Therapy in all Remote States 
pursuant to this Compact, which shall be subject to the 
enforcement jurisdiction of the Licensing Authority in a 
Licensee’s Home State. 
 U. “National Licensing Examination” - A national 
examination developed by a national association of Massage 
Therapy regulatory boards, as defined by Commission Rule, that is 
derived from a practice analysis and is consistent with generally 
accepted psychometric principles of fairness, validity and 
reliability, and is administered under secure and confidential 
examination protocols. 
 V. “Remote State” - any Member State, other than the 
Licensee’s Home State.   
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- 	82nd Session (2023) 
 W. “Rule” - any opinion or regulation promulgated by the 
Commission under this Compact, which shall have the force of 
law. 
 X. “Single-State License” - a current, valid authorization 
issued by a Member State’s Licensing Authority allowing an 
individual to fully practice Massage Therapy, that is not a 
restricted, student, provisional, temporary, or inactive practice 
authorization and authorizes practice only within the issuing 
State. 
 Y. “State” - a state, territory, possession of the United States, 
or the District of Columbia. 
 
ARTICLE 3-MEMBER STATE REQUIREMENTS 
 
 A. To be eligible to join this Compact, and to maintain 
eligibility as a Member State, a State must: 
 1. License and regulate the Practice of Massage Therapy; 
 2. Have a mechanism or entity in place to receive and 
investigate complaints from the public, regulatory or law 
enforcement agencies, or the Commission about Licensees 
practicing in that State; 
 3. Accept passage of a National Licensing Examination as a 
criterion for Massage Therapy licensure in that State; 
 4. Require that Licensees satisfy educational requirements 
prior to being licensed to provide Massage Therapy Services to the 
public in that State; 
 5. Implement procedures for requiring the Background 
Check of applicants for a Multistate License, and for the reporting 
of any Disqualifying Events, including but not limited to obtaining 
and submitting, for each Licensee holding a Multistate License 
and each applicant for a Multistate License, fingerprint or other 
biometric-based information to the Federal Bureau of 
Investigation for Background Checks; receiving the results of the 
Federal Bureau of Investigation record search on Background 
Checks and considering the results of such a Background Check 
in making licensure decisions; 
 6. Have Continuing Competence requirements as a condition 
for license renewal; 
 7. Participate in the Data System, including through the use 
of unique identifying numbers as described herein; 
 8. Notify the Commission and other Member States, in 
compliance with the terms of the Compact and Rules of the 
Commission, of any disciplinary action taken by the State against   
 	– 16 – 
 
 
- 	82nd Session (2023) 
a Licensee practicing under a Multistate License in that State, or 
of the existence of Investigative Information or Current 
Significant Investigative Information regarding a Licensee 
practicing in that State pursuant to a Multistate License; 
 9. Comply with the Rules of the Commission; 
 10. Accept Licensees with valid Multistate Licenses from 
other Member States as established herein; 
 B. Individuals not residing in a Member State shall continue 
to be able to apply for a Member State’s Single-State License as 
provided under the laws of each Member State. However, the 
Single-State License granted to those individuals shall not be 
recognized as granting a Multistate License for Massage Therapy 
in any other Member State; 
 C. Nothing in this Compact shall affect the requirements 
established by a Member State for the issuance of a Single-State 
License; and 
 D. A Multistate License issued to a Licensee shall be 
recognized by each Remote State as an Authorization to Practice 
Massage Therapy in each Remote State. 
 
ARTICLE 4-MULTISTATE LICENSE REQUIREMENTS 
 
 A. To qualify for a Multistate License under this Compact, 
and to maintain eligibility for such a license, an applicant must: 
 1. Hold an active Single-State License to practice Massage 
Therapy in the applicant’s Home State; 
 2. Have completed at least six hundred and twenty-five (625) 
clock hours of Massage Therapy education or the substantial 
equivalent which the Commission may approve by Rule. 
 3. Have passed a National Licensing Examination or the 
substantial equivalent which the Commission may approve by 
Rule; 
 4. Submit to a Background Check; 
 5. Have not been convicted or found guilty, or have entered 
into an agreed disposition, of a felony offense under applicable 
State or federal criminal law, within five (5) years prior to the date 
of their application, where such a time period shall not include 
any time served for the offense, and provided that the applicant 
has completed any and all requirements arising as a result of any 
such offense;  
 6. Have not been convicted or found guilty, or have entered 
into an agreed disposition, of a misdemeanor offense related to the 
Practice of Massage Therapy under applicable State or federal   
 	– 17 – 
 
 
- 	82nd Session (2023) 
criminal law, within two (2) years prior to the date of their 
application where such a time period shall not include any time 
served for the offense, and provided that the applicant has 
completed any and all requirements arising as a result of any such 
offense; 
 7. Have not been convicted or found guilty, or have entered 
into an agreed disposition, of any offense, whether a misdemeanor 
or a felony, under State or federal law, at any time, relating to any 
of the following: 
  a. Kidnapping; 
  b. Human trafficking; 
  c. Human smuggling; 
  d. Sexual battery, sexual assault, or any related offenses; or 
  e. Any other category of offense which the Commission 
may by Rule designate. 
 8. Have not previously held a Massage Therapy license which 
was revoked by, or surrendered in lieu of discipline to an 
applicable Licensing Authority; 
 9. Have no history of any Adverse Action on any 
occupational or professional license within two (2) years prior to 
the date of their application; and 
 10. Pay all required fees. 
 B. A Multistate License granted pursuant to this Compact 
may be effective for a definite period of time concurrent with the 
renewal of the Home State license. 
 C. A Licensee practicing in a Member State is subject to all 
scope of practice laws governing Massage Therapy Services in 
that State. 
 D. The Practice of Massage Therapy under a Multistate 
License granted pursuant to this Compact will subject the 
Licensee to the jurisdiction of the Licensing Authority, the courts, 
and the laws of the Member State in which the Massage Therapy 
Services are provided. 
 
ARTICLE 5-AUTHORITY OF INTERSTATE 
MASSAGE COMPACT COMMISSION AND 
MEMBER STATE LICENSING AUTHORITIES 
 
 A. Nothing in this Compact, nor any Rule of the Commission, 
shall be construed to limit, restrict, or in any way reduce the ability 
of a Member State to enact and enforce laws, regulations, or other 
rules related to the Practice of Massage Therapy in that State,   
 	– 18 – 
 
 
- 	82nd Session (2023) 
where those laws, regulations, or other rules are not inconsistent 
with the provisions of this Compact. 
 B. Nothing in this Compact, nor any Rule of the Commission, 
shall be construed to limit, restrict, or in any way reduce the ability 
of a Member State to take Adverse Action against a Licensee’s 
Single-State License to practice Massage Therapy in that State. 
 C. Nothing in this Compact, nor any Rule of the Commission, 
shall be construed to limit, restrict, or in any way reduce the ability 
of a Remote State to take Adverse Action against a Licensee’s 
Authorization to Practice in that State. 
 D. Nothing in this Compact, nor any Rule of the 
Commission, shall be construed to limit, restrict, or in any way 
reduce the ability of a Licensee’s Home State to take Adverse 
Action against a Licensee’s Multistate License based upon 
information provided by a Remote State.  
 E. Insofar as practical, a Member State’s Licensing Authority 
shall cooperate with the Commission and with each entity 
exercising independent regulatory authority over the Practice of 
Massage Therapy according to the provisions of this Compact. 
 
ARTICLE 6-ADVERSE ACTIONS 
 
 A. A Licensee’s Home State shall have exclusive power to 
impose an Adverse Action against a Licensee’s Multistate License 
issued by the Home State. 
 B. A Home State may take Adverse Action on a Multistate 
License based on the Investigative Information, Current 
Significant Investigative Information, or Adverse Action of a 
Remote State. 
 C. A Home State shall retain authority to complete any 
pending investigations of a Licensee practicing under a Multistate 
License who changes their Home State during the course of such 
an investigation. The Licensing Authority shall also be empowered 
to report the results of such an investigation to the Commission 
through the Data System as described herein. 
 D. Any Member State may investigate actual or alleged 
violations of the scope of practice laws in any other Member State 
for a massage therapist who holds a Multistate License. 
 E. A Remote State shall have the authority to: 
 1. Take Adverse Actions against a Licensee’s Authorization 
to Practice. 
 2. Issue cease and desist orders or impose an Encumbrance 
on a Licensee’s Authorization to Practice in that State.   
 	– 19 – 
 
 
- 	82nd Session (2023) 
 3. Issue subpoenas for both hearings and investigations that 
require the attendance and testimony of witnesses, as well as the 
production of evidence. Subpoenas issued by a Licensing 
Authority in a Member State for the attendance and testimony of 
witnesses or the production of evidence from another Member 
State shall be enforced in the latter State by any court of 
competent jurisdiction, according to the practice and procedure of 
that court applicable to subpoenas issued in proceedings before it. 
The issuing Licensing Authority shall pay any witness fees, travel 
expenses, mileage, and other fees required by the service statutes 
of the State in which the witnesses or evidence are located. 
 4. If otherwise permitted by State law, recover from the 
affected Licensee the costs of investigations and disposition of 
cases resulting from any Adverse Action taken against that 
Licensee.  
 5. Take Adverse Action against the Licensee’s Authorization 
to Practice in that State based on the factual findings of another 
Member State. 
 F. If an Adverse Action is taken by the Home State against a 
Licensee’s Multistate License or Single-State License to practice 
in the Home State, the Licensee’s Authorization to Practice in all 
other Member States shall be deactivated until all Encumbrances 
have been removed from such license. All Home State disciplinary 
orders that impose an Adverse Action against a Licensee shall 
include a statement that the Massage Therapist’s Authorization to 
Practice is deactivated in all Member States during the pendency 
of the order.  
 G. If Adverse Action is taken by a Remote State against a 
Licensee’s Authorization to Practice, that Adverse Action applies 
to all Authorizations to Practice in all Remote States. A Licensee 
whose Authorization to Practice in a Remote State is removed for 
a specified period of time is not eligible to apply for a new 
Multistate License in any other State until the specific time for 
removal of the Authorization to Practice has passed and all 
encumbrance requirements are satisfied.  
 H. Nothing in this Compact shall override a Member State’s 
authority to accept a Licensee’s participation in an Alternative 
Program in lieu of Adverse Action. A Licensee’s Multistate 
License shall be suspended for the duration of the Licensee’s 
participation in any Alternative Program. 
 I. Joint Investigations 
 1. In addition to the authority granted to a Member State by 
its respective scope of practice laws or other applicable State law, a   
 	– 20 – 
 
 
- 	82nd Session (2023) 
Member State may participate with other Member States in joint 
investigations of Licensees.  
 2. Member States shall share any investigative, litigation, or 
compliance materials in furtherance of any joint or individual 
investigation initiated under the Compact. 
 
ARTICLE 7-ACTIVE MILITARY MEMBERS AND THEIR 
SPOUSES 
 
 Active Military Members, or their spouses, shall designate a 
Home State where the individual has a current license to practice 
Massage Therapy in good standing. The individual may retain 
their Home State designation during any period of service when 
that individual or their spouse is on active duty assignment. 
 
ARTICLE 8-ESTABLISHMENT AND OPERATION OF 
INTERSTATE MASSAGE COMPACT COMMISSION 
 
 A. The Compact Member States hereby create and establish a 
joint government agency whose membership consists of all 
Member States that have enacted the Compact known as the 
Interstate Massage Compact Commission. The Commission is an 
instrumentality of the Compact States acting jointly and not an 
instrumentality of any one State. The Commission shall come into 
existence on or after the effective date of the Compact as set forth 
in Article 12. 
 B. Membership, Voting, and Meetings  
 1. Each Member State shall have and be limited to one (1) 
delegate selected by that Member State’s State Licensing 
Authority. 
 2. The delegate shall be the primary administrative officer of 
the State Licensing Authority or their designee. 
 3. The Commission shall by Rule or bylaw establish a term of 
office for delegates and may by Rule or bylaw establish term 
limits. 
 4. The Commission may recommend removal or suspension 
of any delegate from office.  
 5. A Member State’s State Licensing Authority shall fill any 
vacancy of its delegate occurring on the Commission within 60 
days of the vacancy.  
 6. Each delegate shall be entitled to one vote on all matters 
that are voted on by the Commission.    
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- 	82nd Session (2023) 
 7. The Commission shall meet at least once during each 
calendar year. Additional meetings may be held as set forth in the 
bylaws. The Commission may meet by telecommunication, video 
conference or other similar electronic means.  
 C. The Commission shall have the following powers: 
 1. Establish the fiscal year of the Commission; 
 2. Establish code of conduct and conflict of interest policies; 
 3. Adopt Rules and bylaws; 
 4. Maintain its financial records in accordance with the 
bylaws; 
 5. Meet and take such actions as are consistent with the 
provisions of this Compact, the Commission’s Rules, and the 
bylaws; 
 6. Initiate and conclude legal proceedings or actions in the 
name of the Commission, provided that the standing of any State 
Licensing Authority to sue or be sued under applicable law shall 
not be affected; 
 7. Maintain and certify records and information provided to a 
Member State as the authenticated business records of the 
Commission, and designate an agent to do so on the Commission’s 
behalf;  
 8. Purchase and maintain insurance and bonds;  
 9. Borrow, accept, or contract for services of personnel, 
including, but not limited to, employees of a Member State; 
 10. Conduct an annual financial review; 
 11. Hire employees, elect or appoint officers, fix 
compensation, define duties, grant such individuals appropriate 
authority to carry out the purposes of the Compact, and establish 
the Commission’s personnel policies and programs relating to 
conflicts of interest, qualifications of personnel, and other related 
personnel matters; 
 12. Assess and collect fees; 
 13. Accept any and all appropriate gifts, donations, grants of 
money, other sources of revenue, equipment, supplies, materials, 
and services, and receive, utilize, and dispose of the same; 
provided that at all times the Commission shall avoid any 
appearance of impropriety or conflict of interest; 
 14. Lease, purchase, retain, own, hold, improve, or use any 
property, real, personal, or mixed, or any undivided interest 
therein; 
 15. Sell, convey, mortgage, pledge, lease, exchange, abandon, 
or otherwise dispose of any property real, personal, or mixed; 
 16. Establish a budget and make expenditures;   
 	– 22 – 
 
 
- 	82nd Session (2023) 
 17. Borrow money; 
 18. Appoint committees, including standing committees, 
composed of members, State regulators, State legislators or their 
representatives, and consumer representatives, and such other 
interested persons as may be designated in this Compact and the 
bylaws; 
 19. Accept and transmit complaints from the public, 
regulatory or law enforcement agencies, or the Commission, to the 
relevant Member State(s) regarding potential misconduct of 
Licensees; 
 20. Elect a Chair, Vice Chair, Secretary and Treasurer and 
such other officers of the Commission as provided in the 
Commission’s bylaws; 
 21. Establish and elect an Executive Committee, including a 
chair and a vice chair; 
 22. Adopt and provide to the Member States an annual 
report; 
 23. Determine whether a State’s adopted language is 
materially different from the model Compact language such that 
the State would not qualify for participation in the Compact; and 
 24. Perform such other functions as may be necessary or 
appropriate to achieve the purposes of this Compact. 
 D. The Executive Committee 
 1. The Executive Committee shall have the power to act on 
behalf of the Commission according to the terms of this Compact. 
The powers, duties, and responsibilities of the Executive 
Committee shall include: 
  a. Overseeing the day-to-day activities of the administration 
of the Compact including compliance with the provisions of the 
Compact, the Commission’s Rules and bylaws, and other such 
duties as deemed necessary; 
  b. Recommending to the Commission changes to the Rules 
or bylaws, changes to this Compact legislation, fees charged to 
Compact Member States, fees charged to Licensees, and other 
fees; 
  c. Ensuring Compact administration services are 
appropriately provided, including by contract; 
  d. Preparing and recommending the budget; 
  e. Maintaining financial records on behalf of the 
Commission; 
  f. Monitoring Compact compliance of Member States and 
providing compliance reports to the Commission; 
  g. Establishing additional committees as necessary;   
 	– 23 – 
 
 
- 	82nd Session (2023) 
  h. Exercise the powers and duties of the Commission 
during the interim between Commission meetings, except for 
adopting or amending Rules, adopting or amending bylaws, and 
exercising any other powers and duties expressly reserved to the 
Commission by Rule or bylaw; and 
  i. Other duties as provided in the Rules or bylaws of the 
Commission. 
 2. The Executive Committee shall be composed of seven 
voting members and up to two ex-officio members as follows: 
  a. The chair and vice chair of the Commission and any 
other members of the Commission who serve on the Executive 
Committee shall be voting members of the Executive Committee. 
  b. Other than the chair, vice-chair, secretary and treasurer, 
the Commission shall elect three voting members from the current 
membership of the Commission. 
  c. The Commission may elect ex-officio, nonvoting 
members as necessary as follows: 
   i. One ex-officio member who is a representative of the 
national association of State Massage Therapy regulatory boards. 
   ii. One ex-officio member as specified in the 
Commission’s bylaws. 
 3. The Commission may remove any member of the Executive 
Committee as provided in the Commission’s bylaws. 
 4. The Executive Committee shall meet at least annually. 
  a. Executive Committee meetings shall be open to the 
public, except that the Executive Committee may meet in a closed, 
non-public session of a public meeting when dealing with any of 
the matters covered under subsection F.4. 
  b. The Executive Committee shall give five business days 
advance notice of its public meetings, posted on its website and as 
determined to provide notice to persons with an interest in the 
public matters the Executive Committee intends to address at those 
meetings. 
 5. The Executive Committee may hold an emergency meeting 
when acting for the Commission to: 
  a. Meet an imminent threat to public health, safety, or 
welfare; 
  b. Prevent a loss of Commission or Participating State 
funds; or 
  c. Protect public health and safety. 
 E. The Commission shall adopt and provide to the Member 
States an annual report. 
 F. Meetings of the Commission   
 	– 24 – 
 
 
- 	82nd Session (2023) 
 1. All meetings of the Commission that are not closed 
pursuant to this subsection shall be open to the public. Notice of 
public meetings shall be posted on the Commission’s website at 
least thirty (30) days prior to the public meeting. 
 2. Notwithstanding subsection F.1 of this Article, the 
Commission may convene an emergency public meeting by 
providing at least twenty-four (24) hours prior notice on the 
Commission’s website, and any other means as provided in the 
Commission’s Rules, for any of the reasons it may dispense with 
notice of proposed rulemaking under Article 10.L. The 
Commission’s legal counsel shall certify that one of the reasons 
justifying an emergency public meeting has been met. 
 3. Notice of all Commission meetings shall provide the time, 
date, and location of the meeting, and if the meeting is to be held 
or accessible via telecommunication, video conference, or other 
electronic means, the notice shall include the mechanism for 
access to the meeting. 
 4. The Commission may convene in a closed, non-public 
meeting for the Commission to discuss: 
  a. Non-compliance of a Member State with its obligations 
under the Compact; 
  b. The employment, compensation, discipline or other 
matters, practices or procedures related to specific employees or 
other matters related to the Commission’s internal personnel 
practices and procedures; 
  c. Current or threatened discipline of a Licensee by the 
Commission or by a Member State’s Licensing Authority; 
  d. Current, threatened, or reasonably anticipated litigation; 
  e. Negotiation of contracts for the purchase, lease, or sale 
of goods, services, or real estate; 
  f. Accusing any person of a crime or formally censuring 
any person; 
  g. Trade secrets or commercial or financial information 
that is privileged or confidential; 
  h. Information of a personal nature where disclosure would 
constitute a clearly unwarranted invasion of personal privacy; 
  i. Investigative records compiled for law enforcement 
purposes; 
  j. Information related to any investigative reports prepared 
by or on behalf of or for use of the Commission or other 
committee charged with responsibility of investigation or 
determination of compliance issues pursuant to the Compact; 
  k. Legal advice;   
 	– 25 – 
 
 
- 	82nd Session (2023) 
  l. Matters specifically exempted from disclosure to the 
public by federal or Member State law; or 
  m. Other matters as promulgated by the Commission by 
Rule. 
 5. If a meeting, or portion of a meeting, is closed, the 
presiding officer shall state that the meeting will be closed and 
reference each relevant exempting provision, and such reference 
shall be recorded in the minutes. 
 6. The Commission shall keep minutes that fully and clearly 
describe all matters discussed in a meeting and shall provide a full 
and accurate summary of actions taken, and the reasons 
therefore, including a description of the views expressed. All 
documents considered in connection with an action shall be 
identified in such minutes. All minutes and documents of a closed 
meeting shall remain under seal, subject to release only by a 
majority vote of the Commission or order of a court of competent 
jurisdiction. 
 G. Financing of the Commission 
 1. The Commission shall pay, or provide for the payment of, 
the reasonable expenses of its establishment, organization, and 
ongoing activities. 
 2. The Commission may accept any and all appropriate 
sources of revenue, donations, and grants of money, equipment, 
supplies, materials, and services. 
 3. The Commission may levy on and collect an annual 
assessment from each Member State and impose fees on Licensees 
of Member States to whom it grants a Multistate License to cover 
the cost of the operations and activities of the Commission and its 
staff, which must be in a total amount sufficient to cover its 
annual budget as approved each year for which revenue is not 
provided by other sources. The aggregate annual assessment 
amount for Member States shall be allocated based upon a 
formula that the Commission shall promulgate by Rule. 
 4. The Commission shall not incur obligations of any kind 
prior to securing the funds adequate to meet the same; nor shall 
the Commission pledge the credit of any Member States, except by 
and with the authority of the Member State. 
 5. The Commission shall keep accurate accounts of all 
receipts and disbursements. The receipts and disbursements of the 
Commission shall be subject to the financial review and 
accounting procedures established under its bylaws. All receipts 
and disbursements of funds handled by the Commission shall be 
subject to an annual financial review by a certified or licensed   
 	– 26 – 
 
 
- 	82nd Session (2023) 
public accountant, and the report of the financial review shall be 
included in and become part of the annual report of the 
Commission. 
 H. Qualified Immunity, Defense, and Indemnification 
 1. The members, officers, executive director, employees and 
representatives of the Commission shall be immune from suit and 
liability, both personally and in their official capacity, for any 
claim for damage to or loss of property or personal injury or other 
civil liability caused by or arising out of any actual or alleged act, 
error, or omission that occurred, or that the person against whom 
the claim is made had a reasonable basis for believing occurred 
within the scope of Commission employment, duties or 
responsibilities; provided that nothing in this paragraph shall be 
construed to protect any such person from suit or liability for any 
damage, loss, injury, or liability caused by the intentional or 
willful or wanton misconduct of that person. The procurement of 
insurance of any type by the Commission shall not in any way 
compromise or limit the immunity granted hereunder. 
 2. The Commission shall defend any member, officer, 
executive director, employee, and representative of the 
Commission in any civil action seeking to impose liability arising 
out of any actual or alleged act, error, or omission that occurred 
within the scope of Commission employment, duties, or 
responsibilities, or as determined by the Commission that the 
person against whom the claim is made had a reasonable basis for 
believing occurred within the scope of Commission employment, 
duties, or responsibilities; provided that nothing herein shall be 
construed to prohibit that person from retaining their own counsel 
at their own expense; and provided further, that the actual or 
alleged act, error, or omission did not result from that person’s 
intentional or willful or wanton misconduct. 
 3. The Commission shall indemnify and hold harmless any 
member, officer, executive director, employee, and representative 
of the Commission for the amount of any settlement or judgment 
obtained against that person arising out of any actual or alleged 
act, error, or omission that occurred within the scope of 
Commission employment, duties, or responsibilities, or that such 
person had a reasonable basis for believing occurred within the 
scope of Commission employment, duties, or responsibilities, 
provided that the actual or alleged act, error, or omission did not 
result from the intentional or willful or wanton misconduct of that 
person.   
 	– 27 – 
 
 
- 	82nd Session (2023) 
 4. Nothing herein shall be construed as a limitation on the 
liability of any Licensee for professional malpractice or 
misconduct, which shall be governed solely by any other 
applicable State laws. 
 5. Nothing in this Compact shall be interpreted to waive or 
otherwise abrogate a Member State’s State action immunity or 
State action affirmative defense with respect to antitrust claims 
under the Sherman Act, Clayton Act, or any other State or federal 
antitrust or anticompetitive law or regulation. 
 6. Nothing in this Compact shall be construed to be a waiver 
of sovereign immunity by the Member States or by the 
Commission. 
 
ARTICLE 9-DATA SYSTEM 
 
 A. The Commission shall provide for the development, 
maintenance, operation, and utilization of a coordinated database 
and reporting system. 
 B. The Commission shall assign each applicant for a 
Multistate License a unique identifier, as determined by the Rules 
of the Commission. 
 C. Notwithstanding any other provision of State law to the 
contrary, a Member State shall submit a uniform data set to the 
Data System on all individuals to whom this Compact is applicable 
as required by the Rules of the Commission, including: 
 1. Identifying information; 
 2. Licensure data; 
 3. Adverse Actions against a license and information related 
thereto; 
 4. Non-confidential information related to Alternative 
Program participation, the beginning and ending dates of such 
participation, and other information related to such participation; 
 5. Any denial of application for licensure, and the reason(s) 
for such denial (excluding the reporting of any criminal history 
record information where prohibited by law); 
 6. The existence of Investigative Information; 
 7. The existence presence of Current Significant Investigative 
Information; and 
 8. Other information that may facilitate the administration of 
this Compact or the protection of the public, as determined by the 
Rules of the Commission. 
 D. The records and information provided to a Member State 
pursuant to this Compact or through the Data System, when   
 	– 28 – 
 
 
- 	82nd Session (2023) 
certified by the Commission or an agent thereof, shall constitute 
the authenticated business records of the Commission, and shall 
be entitled to any associated hearsay exception in any relevant 
judicial, quasi-judicial or administrative proceedings in a Member 
State.  
 E. The existence of Current Significant Investigative 
Information and the existence of Investigative Information 
pertaining to a Licensee in any Member State will only be 
available to other Member States. 
 F. It is the responsibility of the Member States to report any 
Adverse Action against a Licensee who holds a Multistate License 
and to monitor the database to determine whether Adverse Action 
has been taken against such a Licensee or License applicant. 
Adverse Action information pertaining to a Licensee or License 
applicant in any Member State will be available to any other 
Member State. 
 G. Member States contributing information to the Data 
System may designate information that may not be shared with the 
public without the express permission of the contributing State. 
 H. Any information submitted to the Data System that is 
subsequently expunged pursuant to federal law or the laws of the 
Member State contributing the information shall be removed from 
the Data System. 
 
ARTICLE 10-RULEMAKING 
 
 A. The Commission shall promulgate reasonable Rules in 
order to effectively and efficiently implement and administer the 
purposes and provisions of the Compact. A Rule shall be invalid 
and have no force or effect only if a court of competent 
jurisdiction holds that the Rule is invalid because the Commission 
exercised its rulemaking authority in a manner that is beyond the 
scope and purposes of the Compact, or the powers granted 
hereunder, or based upon another applicable standard of review. 
 B. The Rules of the Commission shall have the force of law 
in each Member State, provided however that where the Rules of 
the Commission conflict with the laws of the Member State that 
establish the Member State’s scope of practice as held by a court 
of competent jurisdiction, the Rules of the Commission shall be 
ineffective in that State to the extent of the conflict. 
 C. The Commission shall exercise its Rulemaking powers 
pursuant to the criteria set forth in this article and the Rules   
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- 	82nd Session (2023) 
adopted thereunder. Rules shall become binding as of the date 
specified by the Commission for each Rule. 
 D. If a majority of the legislatures of the Member States 
rejects a Rule or portion of a Rule, by enactment of a statute or 
resolution in the same manner used to adopt the Compact within 
four (4) years of the date of adoption of the Rule, then such Rule 
shall have no further force and effect in any Member State or to 
any State applying to participate in the Compact. 
 E. Rules shall be adopted at a regular or special meeting of 
the Commission. 
 F. Prior to adoption of a proposed Rule, the Commission 
shall hold a public hearing and allow persons to provide oral and 
written comments, data, facts, opinions, and arguments. 
 G. Prior to adoption of a proposed Rule by the Commission, 
and at least thirty (30) days in advance of the meeting at which the 
Commission will hold a public hearing on the proposed Rule, the 
Commission shall provide a Notice of Proposed Rulemaking: 
 1. On the website of the Commission or other publicly 
accessible platform; 
 2. To persons who have requested notice of the Commission’s 
notices of proposed rulemaking, and 
 3. In such other way(s) as the Commission may by Rule 
specify. 
 H. The Notice of Proposed Rulemaking shall include: 
 1. The time, date, and location of the public hearing at which 
the Commission will hear public comments on the proposed Rule 
and, if different, the time, date, and location of the meeting where 
the Commission will consider and vote on the proposed Rule; 
 2. If the hearing is held via telecommunication, video 
conference, or other electronic means, the Commission shall 
include the mechanism for access to the hearing in the Notice of 
Proposed Rulemaking; 
 3. The text of the proposed Rule and the reason therefor; 
 4. A request for comments on the proposed Rule from any 
interested person; and 
 5. The manner in which interested persons may submit 
written comments. 
 I. All hearings will be recorded. A copy of the recording and 
all written comments and documents received by the Commission 
in response to the proposed Rule shall be available to the public. 
 J. Nothing in this article shall be construed as requiring a 
separate hearing on each Rule. Rules may be grouped for the   
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- 	82nd Session (2023) 
convenience of the Commission at hearings required by this 
article. 
 K. The Commission shall, by majority vote of all 
Commissioners, take final action on the proposed Rule based on 
the Rulemaking record. 
 1. The Commission may adopt changes to the proposed Rule 
provided the changes do not enlarge the original purpose of the 
proposed Rule. 
 2. The Commission shall provide an explanation of the 
reasons for substantive changes made to the proposed Rule as well 
as reasons for substantive changes not made that were 
recommended by commenters. 
 3. The Commission shall determine a reasonable effective 
date for the Rule. Except for an emergency as provided in 
subsection L, the effective date of the Rule shall be no sooner than 
thirty (30) days after the Commission issuing the notice that it 
adopted or amended the Rule. 
 L. Upon determination that an emergency exists, the 
Commission may consider and adopt an emergency Rule with 24 
hours’ notice, provided that the usual Rulemaking procedures 
provided in the Compact and in this article shall be retroactively 
applied to the Rule as soon as reasonably possible, in no event 
later than ninety (90) days after the effective date of the Rule. For 
the purposes of this provision, an emergency Rule is one that must 
be adopted immediately to: 
 1. Meet an imminent threat to public health, safety, or 
welfare; 
 2. Prevent a loss of Commission or Member State funds; 
 3. Meet a deadline for the promulgation of a Rule that is 
established by federal law or rule; or  
 4. Protect public health and safety. 
 M. The Commission or an authorized committee of the 
Commission may direct revisions to a previously adopted Rule for 
purposes of correcting typographical errors, errors in format, 
errors in consistency, or grammatical errors. Public notice of any 
revisions shall be posted on the website of the Commission. The 
revision shall be subject to challenge by any person for a period of 
thirty (30) days after posting. The revision may be challenged only 
on grounds that the revision results in a material change to a 
Rule. A challenge shall be made in writing and delivered to the 
Commission prior to the end of the notice period. If no challenge 
is made, the revision will take effect without further action. If the   
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- 	82nd Session (2023) 
revision is challenged, the revision may not take effect without the 
approval of the Commission. 
 N. No Member State’s rulemaking requirements shall apply 
under this Compact. 
 
ARTICLE 11-OVERSIGHT, DISPUTE 
RESOLUTION, AND ENFORCEMENT 
 
 A. Oversight 
 1. The executive and judicial branches of State government 
in each Member State shall enforce this Compact and take all 
actions necessary and appropriate to implement the Compact. 
 2. Venue is proper and judicial proceedings by or against the 
Commission shall be brought solely and exclusively in a court of 
competent jurisdiction where the principal office of the 
Commission is located. The Commission may waive venue and 
jurisdictional defenses to the extent it adopts or consents to 
participate in alternative dispute resolution proceedings. Nothing 
herein shall affect or limit the selection or propriety of venue in 
any action against a Licensee for professional malpractice, 
misconduct or any such similar matter. 
 3. The Commission shall be entitled to receive service of 
process in any proceeding regarding the enforcement or 
interpretation of the Compact and shall have standing to intervene 
in such a proceeding for all purposes. Failure to provide the 
Commission service of process shall render a judgment or order 
void as to the Commission, this Compact, or promulgated Rules. 
 B. Default, Technical Assistance, and Termination 
 1. If the Commission determines that a Member State has 
defaulted in the performance of its obligations or responsibilities 
under this Compact or the promulgated Rules, the Commission 
shall provide written notice to the defaulting State. The notice of 
default shall describe the default, the proposed means of curing 
the default, and any other action that the Commission may take, 
and shall offer training and specific technical assistance 
regarding the default.  
 2. The Commission shall provide a copy of the notice of 
default to the other Member States. 
 C. If a State in default fails to cure the default, the defaulting 
State may be terminated from the Compact upon an affirmative 
vote of a majority of the delegates of the Member States, and all 
rights, privileges and benefits conferred on that State by this 
Compact may be terminated on the effective date of termination. A   
 	– 32 – 
 
 
- 	82nd Session (2023) 
cure of the default does not relieve the offending State of 
obligations or liabilities incurred during the period of default.  
 D. Termination of membership in the Compact shall be 
imposed only after all other means of securing compliance have 
been exhausted. Notice of intent to suspend or terminate shall be 
given by the Commission to the governor, the majority and 
minority leaders of the defaulting State’s legislature, the 
defaulting State’s State Licensing Authority and each of the 
Member States’ State Licensing Authority. 
 E. A State that has been terminated is responsible for all 
assessments, obligations, and liabilities incurred through the 
effective date of termination, including obligations that extend 
beyond the effective date of termination. 
 F. Upon the termination of a State’s membership from this 
Compact, that State shall immediately provide notice to all 
Licensees who hold a Multistate License within that State of such 
termination. The terminated State shall continue to recognize all 
licenses granted pursuant to this Compact for a minimum of one 
hundred eighty (180) days after the date of said notice of 
termination. 
 G. The Commission shall not bear any costs related to a State 
that is found to be in default or that has been terminated from the 
Compact, unless agreed upon in writing between the Commission 
and the defaulting State. 
 H. The defaulting State may appeal the action of the 
Commission by petitioning the U.S. District Court for the District 
of Columbia or the federal district where the Commission has its 
principal offices. The prevailing party shall be awarded all costs of 
such litigation, including reasonable attorney’s fees.  
 I. Dispute Resolution 
 1. Upon request by a Member State, the Commission shall 
attempt to resolve disputes related to the Compact that arise 
among Member States and between Member and non-Member 
States. 
 2. The Commission shall promulgate a Rule providing for 
both mediation and binding dispute resolution for disputes as 
appropriate. 
 J. Enforcement 
 1. The Commission, in the reasonable exercise of its 
discretion, shall enforce the provisions of this Compact and the 
Commission’s Rules. 
 2. By majority vote as provided by Commission Rule, the 
Commission may initiate legal action against a Member State in   
 	– 33 – 
 
 
- 	82nd Session (2023) 
default in the United States District Court for the District of 
Columbia or the federal district where the Commission has its 
principal offices to enforce compliance with the provisions of the 
Compact and its promulgated Rules. The relief sought may 
include both injunctive relief and damages. In the event judicial 
enforcement is necessary, the prevailing party shall be awarded all 
costs of such litigation, including reasonable attorney’s fees. The 
remedies herein shall not be the exclusive remedies of the 
Commission. The Commission may pursue any other remedies 
available under federal or the defaulting Member State’s law. 
 3. A Member State may initiate legal action against the 
Commission in the U.S. District Court for the District of Columbia 
or the federal district where the Commission has its principal 
offices to enforce compliance with the provisions of the Compact 
and its promulgated Rules. The relief sought may include both 
injunctive relief and damages. In the event judicial enforcement is 
necessary, the prevailing party shall be awarded all costs of such 
litigation, including reasonable attorney’s fees. 
 4. No individual or entity other than a Member State may 
enforce this Compact against the Commission. 
 
ARTICLE 12-EFFECTIVE DATE, WITHDRAWAL, 
AND AMENDMENT 
 
 A. The Compact shall come into effect on the date on which 
the Compact statute is enacted into law in the seventh Member 
State. 
 1. On or after the effective date of the Compact, the 
Commission shall convene and review the enactment of each of 
the Charter Member States to determine if the statute enacted by 
each such Charter Member State is materially different than the 
model Compact statute. 
  a. A Charter Member State whose enactment is found to be 
materially different from the model Compact statute shall be 
entitled to the default process set forth in Article 11. 
  b. If any Member State is later found to be in default, or is 
terminated or withdraws from the Compact, the Commission shall 
remain in existence and the Compact shall remain in effect even if 
the number of Member States should be less than seven (7). 
 2. Member States enacting the Compact subsequent to the 
Charter Member States shall be subject to the process set forth in 
Article 8.C.23 to determine if their enactments are materially   
 	– 34 – 
 
 
- 	82nd Session (2023) 
different from the model Compact statute and whether they qualify 
for participation in the Compact.  
 3. All actions taken for the benefit of the Commission or in 
furtherance of the purposes of the administration of the Compact 
prior to the effective date of the Compact or the Commission 
coming into existence shall be considered to be actions of the 
Commission unless specifically repudiated by the Commission. 
 4. Any State that joins the Compact shall be subject to the 
Commission’s Rules and bylaws as they exist on the date on which 
the Compact becomes law in that State. Any Rule that has been 
previously adopted by the Commission shall have the full force 
and effect of law on the day the Compact becomes law in that 
State. 
 B. Any Member State may withdraw from this Compact by 
enacting a statute repealing that State’s enactment of the 
Compact.  
 1. A Member State’s withdrawal shall not take effect until 
one hundred eighty (180) days after enactment of the repealing 
statute. 
 2. Withdrawal shall not affect the continuing requirement of 
the withdrawing State’s Licensing Authority to comply with the 
investigative and Adverse Action reporting requirements of this 
Compact prior to the effective date of withdrawal.  
 3. Upon the enactment of a statute withdrawing from this 
Compact, a State shall immediately provide notice of such 
withdrawal to all Licensees within that State. Notwithstanding any 
subsequent statutory enactment to the contrary, such withdrawing 
State shall continue to recognize all licenses granted pursuant to 
this Compact for a minimum of 180 days after the date of such 
notice of withdrawal. 
 C. Nothing contained in this Compact shall be construed to 
invalidate or prevent any licensure agreement or other cooperative 
arrangement between a Member State and a non-Member State 
that does not conflict with the provisions of this Compact. 
 D. This Compact may be amended by the Member States. No 
amendment to this Compact shall become effective and binding 
upon any Member State until it is enacted into the laws of all 
Member States. 
 
ARTICLE 13. CONSTRUCTION AND SEVERABILITY 
 
 A. This Compact and the Commission’s rulemaking authority 
shall be liberally construed so as to effectuate the purposes, and   
 	– 35 – 
 
 
- 	82nd Session (2023) 
the implementation and administration of the Compact. Provisions 
of the Compact expressly authorizing or requiring the 
promulgation of Rules shall not be construed to limit the 
Commission’s rulemaking authority solely for those purposes. 
 B. The provisions of this Compact shall be severable and if 
any phrase, clause, sentence or provision of this Compact is held 
by a court of competent jurisdiction to be contrary to the 
constitution of any Member State, a State seeking participation in 
the Compact, or of the United States, or the applicability thereof to 
any government, agency, person or circumstance is held to be 
unconstitutional by a court of competent jurisdiction, the validity 
of the remainder of this Compact and the applicability thereof to 
any other government, agency, person or circumstance shall not 
be affected thereby. 
 C. Notwithstanding subsection B of this article, the 
Commission may deny a State’s participation in the Compact or, 
in accordance with the requirements of Article 11.B, terminate a 
Member State’s participation in the Compact, if it determines that 
a constitutional requirement of a Member State is a material 
departure from the Compact. Otherwise, if this Compact shall be 
held to be contrary to the constitution of any Member State, the 
Compact shall remain in full force and effect as to the remaining 
Member States and in full force and effect as to the Member State 
affected as to all severable matters. 
 
ARTICLE 14. CONSISTENT EFFECT AND 
CONFLICT WITH OTHER STATE LAWS 
 
 Nothing herein shall prevent or inhibit the enforcement of any 
other law of a Member State that is not inconsistent with the 
Compact. 
 Any laws, statutes, regulations, or other legal requirements in a 
Member State in conflict with the Compact are superseded to the 
extent of the conflict. 
 All permissible agreements between the Commission and the 
Member States are binding in accordance with their terms. 
 Sec. 8.  NRS 640C.180 is hereby amended to read as follows: 
 640C.180 1.  At the first meeting of each fiscal year, the 
members of the Board shall elect a Chair, Vice Chair and Secretary-
Treasurer from among the members. 
 2.  The Board shall meet at least quarterly and may meet at 
other times at the call of the Chair or upon the written request of a 
majority of the members of the Board.   
 	– 36 – 
 
 
- 	82nd Session (2023) 
 3.  The Board shall alternate the location of its meetings 
between the southern district of Nevada and the northern district of 
Nevada. For the purposes of this subsection: 
 (a) The southern district of Nevada consists of all that portion of 
the State lying within the boundaries of the counties of Clark, 
Esmeralda, Lincoln and Nye. 
 (b) The northern district of Nevada consists of all that portion of 
the State lying within the boundaries of Carson City and the 
counties of Churchill, Douglas, Elko, Eureka, Humboldt, Lander, 
Lyon, Mineral, Pershing, Storey, Washoe and White Pine. 
 4.  A meeting of the Board may be conducted telephonically or 
by videoconferencing. A meeting conducted telephonically or by 
videoconferencing must meet the requirements of chapter 241 of 
NRS and any other applicable provisions of law. 
 5.  [Four] Five members of the Board constitute a quorum for 
the purposes of transacting the business of the Board, including, 
without limitation, issuing, renewing, suspending, revoking or 
reinstating a license issued pursuant to this chapter. 
 Sec. 9.  NRS 683A.178 is hereby amended to read as follows: 
 683A.178 1. A pharmacy benefit manager has an obligation 
of good faith and fair dealing toward a third party or pharmacy 
when performing duties pursuant to a contract to which the 
pharmacy benefit manager is a party. Any provision of a contract 
that waives or limits that obligation is against public policy, void 
and unenforceable. 
 2. A pharmacy benefit manager shall notify a third party with 
which it has entered into a contract in writing of any activity, policy 
or practice of the pharmacy benefit manager that presents a conflict 
of interest that interferes with the obligations imposed by  
subsection 1. 
 3. A pharmacy benefit manager that manages prescription 
drug benefits for an insurer licensed pursuant to this title shall 
comply with the provisions of this title which are applicable to the 
insurer when managing such benefits for the insurer. 
 Sec. 10.  Chapter 687B of NRS is hereby amended by adding 
thereto a new section to read as follows: 
 1. A health carrier which offers or issues a network plan:  
 (a) Must demonstrate the capacity to adequately deliver family 
planning services provided by pharmacists or pharmacies to 
covered persons in accordance with the regulations adopted 
pursuant to subsection 2. 
 (b) Shall make available to each covered person in this State a 
notice that meets the requirements prescribed by the regulations   
 	– 37 – 
 
 
- 	82nd Session (2023) 
adopted pursuant to subsection 2 of each pharmacist or pharmacy 
that has entered into a provider network contract with the carrier 
to provide family planning services to covered persons who 
participate in the relevant network plan. 
 2. The Commissioner shall adopt regulations to carry out the 
provisions of this section, including, without limitation, 
regulations prescribing requirements for: 
 (a) A health carrier to demonstrate compliance with paragraph 
(a) of subsection 1. Those regulations must not allow a health 
carrier to demonstrate the capacity to adequately deliver family 
planning services to covered persons by demonstrating that the 
health carrier has entered into a network contract with one or 
more pharmacies for the sole purpose of dispensing prescription 
drugs to covered persons. 
 (b) The form and contents of the notice required by paragraph 
(b) of subsection 1. 
 Sec. 11.  NRS 687B.225 is hereby amended to read as follows: 
 687B.225 1.  Except as otherwise provided in NRS 
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.044, 
689A.0445, 689B.031, 689B.0313, 689B.0315, 689B.0317, 
689B.0374, 689B.0378, 689C.1675, 689C.1676, 695A.1856, 
695A.1865, 695B.1912, 695B.1913, 695B.1914, 695B.1919, 
695B.1925, 695B.1942, 695C.1696, 695C.1713, 695C.1735, 
695C.1737, 695C.1745, 695C.1751, 695G.170, 695G.171, 
695G.1714 , 695G.1715 and 695G.177, any contract for group, 
blanket or individual health insurance or any contract by a nonprofit 
hospital, medical or dental service corporation or organization for 
dental care which provides for payment of a certain part of medical 
or dental care may require the insured or member to obtain prior 
authorization for that care from the insurer or organization. The 
insurer or organization shall: 
 (a) File its procedure for obtaining approval of care pursuant to 
this section for approval by the Commissioner; and 
 (b) Respond to any request for approval by the insured or 
member pursuant to this section within 20 days after it receives the 
request. 
 2.  The procedure for prior authorization may not discriminate 
among persons licensed to provide the covered care. 
 Sec. 12.  NRS 687B.600 is hereby amended to read as follows: 
 687B.600 As used in NRS 687B.600 to 687B.850, inclusive, 
and section 11 of this act, unless the context otherwise requires, the 
words and terms defined in NRS 687B.602 to 687B.665, inclusive, 
have the meanings ascribed to them in those sections.   
 	– 38 – 
 
 
- 	82nd Session (2023) 
 Sec. 13.  NRS 687B.670 is hereby amended to read as follows: 
 687B.670 If a health carrier offers or issues a network plan, the 
health carrier shall, with regard to that network plan: 
 1.  Comply with all applicable requirements set forth in NRS 
687B.600 to 687B.850, inclusive [;] , and section 11 of this act; 
 2.  As applicable, ensure that each contract entered into for the 
purposes of the network plan between a participating provider of 
health care and the health carrier complies with the requirements set 
forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 11 
of this act; and 
 3.  As applicable, ensure that the network plan complies with 
the requirements set forth in NRS 687B.600 to 687B.850, inclusive 
[.] , and section 11 of this act. 
 Sec. 14.  NRS 689A.0418 is hereby amended to read as 
follows: 
 689A.0418 1.  Except as otherwise provided in subsection [7,] 
8, an insurer that offers or issues a policy of health insurance shall 
include in the policy coverage for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration;  
  (3) Listed in subsection [10;] 11; and 
  (4) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Listed in subsection [10;] 11; 
 (c) Self-administered hormonal contraceptives dispensed by a 
pharmacist pursuant to NRS 639.28078; 
 (d) Insertion of a device for contraception or removal of such a 
device if the device was inserted while the insured was covered by 
the same policy of health insurance; 
 (e) Education and counseling relating to the initiation of the use 
of contraception and any necessary follow-up after initiating such 
use; 
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2.  An insurer shall provide coverage for any services listed in 
subsection 1 which are within the authorized scope of practice of a 
pharmacist when such services are provided by a pharmacist who 
is employed by or serves as an independent contractor of an in-
network pharmacy and in accordance with the applicable provider   
 	– 39 – 
 
 
- 	82nd Session (2023) 
network contract. Such coverage must be provided to the same 
extent as if the services were provided by another provider of 
health care, as applicable to the services being provided. The terms 
of the policy must not limit: 
 (a) Coverage for services listed in subsection 1 and provided by 
such a pharmacist to a number of occasions less than the coverage 
for such services when provided by another provider of health 
care. 
 (b) Reimbursement for services listed in subsection 1 and 
provided by such a pharmacist to an amount less than the amount 
reimbursed for similar services provided by a physician, physician 
assistant or advanced practice registered nurse. 
 3. An insurer must ensure that the benefits required by 
subsection 1 are made available to an insured through a provider of 
health care who participates in the network plan of the insurer. 
 [3.] 4.  If a covered therapeutic equivalent listed in subsection 1 
is not available or a provider of health care deems a covered 
therapeutic equivalent to be medically inappropriate, an alternate 
therapeutic equivalent prescribed by a provider of health care must 
be covered by the insurer. 
 [4.] 5.  Except as otherwise provided in subsections [8,] 9 , 10 
and [11,] 12, an insurer that offers or issues a policy of health 
insurance shall not: 
 (a) Require an insured to pay a higher deductible, any 
copayment or coinsurance or require a longer waiting period or 
other condition for coverage to obtain any benefit included in the 
policy pursuant to subsection 1; 
 (b) Refuse to issue a policy of health insurance or cancel a 
policy of health insurance solely because the person applying for or 
covered by the policy uses or may use any such benefit; 
 (c) Offer or pay any type of material inducement or financial 
incentive to an insured to discourage the insured from obtaining any 
such benefit; 
 (d) Penalize a provider of health care who provides any such 
benefit to an insured, including, without limitation, reducing the 
reimbursement of the provider of health care; 
 (e) Offer or pay any type of material inducement, bonus or other 
financial incentive to a provider of health care to deny, reduce, 
withhold, limit or delay access to any such benefit to an insured; or 
 (f) Impose any other restrictions or delays on the access of an 
insured any such benefit. 
 [5.] 6.  Coverage pursuant to this section for the covered 
dependent of an insured must be the same as for the insured.   
 	– 40 – 
 
 
- 	82nd Session (2023) 
 [6.] 7.  Except as otherwise provided in subsection [7,] 8, a 
policy subject to the provisions of this chapter that is delivered, 
issued for delivery or renewed on or after January 1, [2022,] 2024, 
has the legal effect of including the coverage required by 
[subsection 1,] this section, and any provision of the policy or the 
renewal which is in conflict with this section is void. 
 [7.] 8.  An insurer that offers or issues a policy of health 
insurance and which is affiliated with a religious organization is not 
required to provide the coverage required by subsection 1 if the 
insurer objects on religious grounds. Such an insurer shall, before 
the issuance of a policy of health insurance and before the renewal 
of such a policy, provide to the prospective insured written notice of 
the coverage that the insurer refuses to provide pursuant to this 
subsection. 
 [8.] 9.  An insurer may require an insured to pay a higher 
deductible, copayment or coinsurance for a drug for contraception if 
the insured refuses to accept a therapeutic equivalent of the drug. 
 [9.] 10.  For each of the 18 methods of contraception listed in 
subsection [10] 11 that have been approved by the Food and Drug 
Administration, a policy of health insurance must include at least 
one drug or device for contraception within each method for which 
no deductible, copayment or coinsurance may be charged to the 
insured, but the insurer may charge a deductible, copayment or 
coinsurance for any other drug or device that provides the same 
method of contraception. If the insurer charges a copayment or 
coinsurance for a drug for contraception, the insurer may only 
require an insured to pay the copayment or coinsurance: 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed. 
 [10.] 11.  The following 18 methods of contraception must be 
covered pursuant to this section: 
 (a) Voluntary sterilization for women; 
 (b) Surgical sterilization implants for women; 
 (c) Implantable rods; 
 (d) Copper-based intrauterine devices; 
 (e) Progesterone-based intrauterine devices; 
 (f) Injections; 
 (g) Combined estrogen- and progestin-based drugs; 
 (h) Progestin-based drugs; 
 (i) Extended- or continuous-regimen drugs; 
 (j) Estrogen- and progestin-based patches; 
 (k) Vaginal contraceptive rings;   
 	– 41 – 
 
 
- 	82nd Session (2023) 
 (l) Diaphragms with spermicide; 
 (m) Sponges with spermicide; 
 (n) Cervical caps with spermicide; 
 (o) Female condoms; 
 (p) Spermicide; 
 (q) Combined estrogen- and progestin-based drugs for 
emergency contraception or progestin-based drugs for emergency 
contraception; and 
 (r) Ulipristal acetate for emergency contraception. 
 [11.] 12.  Except as otherwise provided in this section and 
federal law, an insurer may use medical management techniques, 
including, without limitation, any available clinical evidence, to 
determine the frequency of or treatment relating to any benefit 
required by this section or the type of provider of health care to use 
for such treatment. 
 [12.] 13.  An insurer shall not [use] : 
 (a) Use medical management techniques to require an insured to 
use a method of contraception other than the method prescribed or 
ordered by a provider of health care [.] ; or 
 (b) Require an insured to obtain prior authorization for the 
benefits described in paragraphs (a) and (c) of subsection 1. 
 [13.] 14.  An insurer must provide an accessible, transparent 
and expedited process which is not unduly burdensome by which an 
insured, or the authorized representative of the insured, may request 
an exception relating to any medical management technique used by 
the insurer to obtain any benefit required by this section without a 
higher deductible, copayment or coinsurance. 
 [14.] 15.  As used in this section: 
 (a) “In-network pharmacy” means a pharmacy that has 
entered into a contract with an insurer to provide services to 
insureds through a network plan offered or issued by the insurer.  
 (b) “Medical management technique” means a practice which is 
used to control the cost or utilization of health care services or 
prescription drug use. The term includes, without limitation, the use 
of step therapy, prior authorization or categorizing drugs and 
devices based on cost, type or method of administration. 
 [(b)] (c) “Network plan” means a policy of health insurance 
offered by an insurer under which the financing and delivery of 
medical care, including items and services paid for as medical care, 
are provided, in whole or in part, through a defined set of providers 
under contract with the insurer. The term does not include an 
arrangement for the financing of premiums.   
 	– 42 – 
 
 
- 	82nd Session (2023) 
 [(c)] (d) “Provider network contract” means a contract 
between an insurer and a provider of health care or pharmacy 
specifying the rights and responsibilities of the insurer and the 
provider of health care or pharmacy, as applicable, for delivery of 
health care services pursuant to a network plan. 
 (e) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 [(d)] (f) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 15.  NRS 689B.0378 is hereby amended to read as 
follows: 
 689B.0378 1.  Except as otherwise provided in subsection [7,] 
8, an insurer that offers or issues a policy of group health insurance 
shall include in the policy coverage for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration;  
  (3) Listed in subsection [11;] 12; and 
  (4) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Listed in subsection [11;] 12; 
 (c) Self-administered hormonal contraceptives dispensed by a 
pharmacist pursuant to NRS 639.28078; 
 (d) Insertion of a device for contraception or removal of such a 
device if the device was inserted while the insured was covered by 
the same policy of group health insurance; 
 (e) Education and counseling relating to the initiation of the use 
of contraception and any necessary follow-up after initiating such 
use;  
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2.  An insurer shall provide coverage for any services listed in 
subsection 1 which are within the authorized scope of practice of a   
 	– 43 – 
 
 
- 	82nd Session (2023) 
pharmacist when such services are provided by a pharmacist who 
is employed by or serves as an independent contractor of an in-
network pharmacy and in accordance with the applicable network 
contract. Such coverage must be provided to the same extent as if 
the services were provided by another provider of health care, as 
applicable to the services being provided. The terms of the policy 
must not limit: 
 (a) Coverage for services listed in subsection 1 and provided by 
such a pharmacist to a number of occasions less than the coverage 
for such services when provided by another provider of health 
care. 
 (b) Reimbursement for services listed in subsection 1 and 
provided by such a pharmacist to an amount less than the amount 
reimbursed for similar services provided by a physician, physician 
assistant or advanced practice registered nurse. 
 3. An insurer must ensure that the benefits required by 
subsection 1 are made available to an insured through a provider of 
health care who participates in the network plan of the insurer. 
 [3.] 4.  If a covered therapeutic equivalent listed in subsection 1 
is not available or a provider of health care deems a covered 
therapeutic equivalent to be medically inappropriate, an alternate 
therapeutic equivalent prescribed by a provider of health care must 
be covered by the insurer. 
 [4.] 5.  Except as otherwise provided in subsections [9,] 10 , 11 
and [12,] 13, an insurer that offers or issues a policy of group health 
insurance shall not: 
 (a) Require an insured to pay a higher deductible, any 
copayment or coinsurance or require a longer waiting period or 
other condition to obtain any benefit included in the policy pursuant 
to subsection 1; 
 (b) Refuse to issue a policy of group health insurance or cancel a 
policy of group health insurance solely because the person applying 
for or covered by the policy uses or may use any such benefit; 
 (c) Offer or pay any type of material inducement or financial 
incentive to an insured to discourage the insured from obtaining any 
such benefit; 
 (d) Penalize a provider of health care who provides any such 
benefit to an insured, including, without limitation, reducing the 
reimbursement to the provider of health care; 
 (e) Offer or pay any type of material inducement, bonus or other 
financial incentive to a provider of health care to deny, reduce, 
withhold, limit or delay access to any such benefit to an insured; or    
 	– 44 – 
 
 
- 	82nd Session (2023) 
 (f) Impose any other restrictions or delays on the access of an 
insured to any such benefit.  
 [5.] 6.  Coverage pursuant to this section for the covered 
dependent of an insured must be the same as for the insured. 
 [6.] 7.  Except as otherwise provided in subsection [7,] 8, a 
policy subject to the provisions of this chapter that is delivered, 
issued for delivery or renewed on or after January 1, [2022,] 2024, 
has the legal effect of including the coverage required by 
[subsection 1,] this section, and any provision of the policy or the 
renewal which is in conflict with this section is void. 
 [7.] 8.  An insurer that offers or issues a policy of group health 
insurance and which is affiliated with a religious organization is not 
required to provide the coverage required by subsection 1 if the 
insurer objects on religious grounds. Such an insurer shall, before 
the issuance of a policy of group health insurance and before the 
renewal of such a policy, provide to the group policyholder or 
prospective insured, as applicable, written notice of the coverage 
that the insurer refuses to provide pursuant to this subsection. 
 [8.] 9.  If an insurer refuses, pursuant to subsection [7,] 8, to 
provide the coverage required by subsection 1, an employer may 
otherwise provide for the coverage for the employees of the 
employer. 
 [9.] 10.  An insurer may require an insured to pay a higher 
deductible, copayment or coinsurance for a drug for contraception if 
the insured refuses to accept a therapeutic equivalent of the drug. 
 [10.] 11.  For each of the 18 methods of contraception listed in 
subsection [11] 12 that have been approved by the Food and Drug 
Administration, a policy of group health insurance must include at 
least one drug or device for contraception within each method for 
which no deductible, copayment or coinsurance may be charged to 
the insured, but the insurer may charge a deductible, copayment or 
coinsurance for any other drug or device that provides the same 
method of contraception. If the insurer charges a copayment or 
coinsurance for a drug for contraception, the insurer may only 
require an insured to pay the copayment or coinsurance: 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed. 
 [11.] 12.  The following 18 methods of contraception must be 
covered pursuant to this section: 
 (a) Voluntary sterilization for women; 
 (b) Surgical sterilization implants for women; 
 (c) Implantable rods;   
 	– 45 – 
 
 
- 	82nd Session (2023) 
 (d) Copper-based intrauterine devices; 
 (e) Progesterone-based intrauterine devices; 
 (f) Injections; 
 (g) Combined estrogen- and progestin-based drugs; 
 (h) Progestin-based drugs; 
 (i) Extended- or continuous-regimen drugs; 
 (j) Estrogen- and progestin-based patches; 
 (k) Vaginal contraceptive rings; 
 (l) Diaphragms with spermicide; 
 (m) Sponges with spermicide; 
 (n) Cervical caps with spermicide; 
 (o) Female condoms; 
 (p) Spermicide; 
 (q) Combined estrogen- and progestin-based drugs for 
emergency contraception or progestin-based drugs for emergency 
contraception; and 
 (r) Ulipristal acetate for emergency contraception. 
 [12.] 13.  Except as otherwise provided in this section and 
federal law, an insurer may use medical management techniques, 
including, without limitation, any available clinical evidence, to 
determine the frequency of or treatment relating to any benefit 
required by this section or the type of provider of health care to use 
for such treatment. 
 [13.] 14.  An insurer shall not [use] : 
 (a) Use medical management techniques to require an insured to 
use a method of contraception other than the method prescribed or 
ordered by a provider of health care [.] ; or 
 (b) Require an insured to obtain prior authorization for the 
benefits described in paragraphs (a) and (c) of subsection 1. 
 [14.] 15.  An insurer must provide an accessible, transparent 
and expedited process which is not unduly burdensome by which an 
insured, or the authorized representative of the insured, may request 
an exception relating to any medical management technique used by 
the insurer to obtain any benefit required by this section without a 
higher deductible, copayment or coinsurance. 
 [15.] 16.  As used in this section: 
 (a) “In-network pharmacy” means a pharmacy that has 
entered into a contract with an insurer to provide services to 
insureds through a network plan offered or issued by the insurer. 
 (b) “Medical management technique” means a practice which is 
used to control the cost or utilization of health care services or 
prescription drug use. The term includes, without limitation, the use   
 	– 46 – 
 
 
- 	82nd Session (2023) 
of step therapy, prior authorization or categorizing drugs and 
devices based on cost, type or method of administration. 
 [(b)] (c) “Network plan” means a policy of group health 
insurance offered by an insurer under which the financing and 
delivery of medical care, including items and services paid for as 
medical care, are provided, in whole or in part, through a defined set 
of providers under contract with the insurer. The term does not 
include an arrangement for the financing of premiums. 
 [(c)] (d) “Provider network contract” means a contract 
between an insurer and a provider of health care or pharmacy 
specifying the rights and responsibilities of the insurer and the 
provider of health care or pharmacy, as applicable, for delivery of 
health care services pursuant to a network plan. 
 (e) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 [(d)] (f) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 16.  NRS 689C.1676 is hereby amended to read as 
follows: 
 689C.1676 1.  Except as otherwise provided in subsection [7,] 
8, a carrier that offers or issues a health benefit plan shall include in 
the plan coverage for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration;  
  (3) Listed in subsection [10;] 11; and 
  (4) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Listed in subsection [10;] 11; 
 (c) Self-administered hormonal contraceptives dispensed by a 
pharmacist pursuant to NRS 639.28078;   
 	– 47 – 
 
 
- 	82nd Session (2023) 
 (d) Insertion of a device for contraception or removal of such a 
device if the device was inserted while the insured was covered by 
the same health benefit plan; 
 (e) Education and counseling relating to the initiation of the use 
of contraception and any necessary follow-up after initiating such 
use;  
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2.  A carrier shall provide coverage for any services listed in 
subsection 1 which are within the authorized scope of practice of a 
pharmacist when such services are provided by a pharmacist who 
is employed by or serves as an independent contractor of an in-
network pharmacy and in accordance with the applicable provider 
network contract. Such coverage must be provided to the same 
extent as if the services were provided by another provider of 
health care, as applicable to the services being provided. The terms 
of the policy must not limit: 
 (a) Coverage for services listed in subsection 1 and provided by 
such a pharmacist to a number of occasions less than the coverage 
for such services when provided by another provider of health 
care. 
 (b) Reimbursement for services listed in subsection 1 and 
provided by such a pharmacist to an amount less than the amount 
reimbursed for similar services provided by a physician, physician 
assistant or advanced practice registered nurse. 
 3. A carrier must ensure that the benefits required by 
subsection 1 are made available to an insured through a provider of 
health care who participates in the network plan of the carrier. 
 [3.] 4.  If a covered therapeutic equivalent listed in subsection 1 
is not available or a provider of health care deems a covered 
therapeutic equivalent to be medically inappropriate, an alternate 
therapeutic equivalent prescribed by a provider of health care must 
be covered by the carrier. 
 [4.] 5.  Except as otherwise provided in subsections [8,] 9 , 10 
and [11,] 12, a carrier that offers or issues a health benefit plan shall 
not: 
 (a) Require an insured to pay a higher deductible, any 
copayment or coinsurance or require a longer waiting period or 
other condition to obtain any benefit included in the health benefit 
plan pursuant to subsection 1; 
 (b) Refuse to issue a health benefit plan or cancel a health 
benefit plan solely because the person applying for or covered by 
the plan uses or may use any such benefit;   
 	– 48 – 
 
 
- 	82nd Session (2023) 
 (c) Offer or pay any type of material inducement or financial 
incentive to an insured to discourage the insured from obtaining any 
such benefit; 
 (d) Penalize a provider of health care who provides any such 
benefit to an insured, including, without limitation, reducing the 
reimbursement to the provider of health care; 
 (e) Offer or pay any type of material inducement, bonus or other 
financial incentive to a provider of health care to deny, reduce, 
withhold, limit or delay access to any such benefit to an insured; or 
 (f) Impose any other restrictions or delays on the access of an 
insured to any such benefit.  
 [5.] 6.  Coverage pursuant to this section for the covered 
dependent of an insured must be the same as for the insured. 
 [6.] 7.  Except as otherwise provided in subsection [7,] 8, a 
health benefit plan subject to the provisions of this chapter that is 
delivered, issued for delivery or renewed on or after January 1, 
[2022,] 2024, has the legal effect of including the coverage required 
by [subsection 1,] this section, and any provision of the plan or the 
renewal which is in conflict with this section is void. 
 [7.] 8.  A carrier that offers or issues a health benefit plan and 
which is affiliated with a religious organization is not required to 
provide the coverage required by subsection 1 if the carrier objects 
on religious grounds. Such a carrier shall, before the issuance of a 
health benefit plan and before the renewal of such a plan, provide to 
the prospective insured written notice of the coverage that the 
carrier refuses to provide pursuant to this subsection. 
 [8.] 9.  A carrier may require an insured to pay a higher 
deductible, copayment or coinsurance for a drug for contraception if 
the insured refuses to accept a therapeutic equivalent of the drug. 
 [9.] 10.  For each of the 18 methods of contraception listed in 
subsection [10] 11 that have been approved by the Food and Drug 
Administration, a health benefit plan must include at least one drug 
or device for contraception within each method for which no 
deductible, copayment or coinsurance may be charged to the 
insured, but the carrier may charge a deductible, copayment or 
coinsurance for any other drug or device that provides the same 
method of contraception. If the carrier charges a copayment or 
coinsurance for a drug for contraception, the carrier may only 
require an insured to pay the copayment or coinsurance: 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed.   
 	– 49 – 
 
 
- 	82nd Session (2023) 
 [10.] 11.  The following 18 methods of contraception must be 
covered pursuant to this section: 
 (a) Voluntary sterilization for women; 
 (b) Surgical sterilization implants for women; 
 (c) Implantable rods; 
 (d) Copper-based intrauterine devices; 
 (e) Progesterone-based intrauterine devices; 
 (f) Injections; 
 (g) Combined estrogen- and progestin-based drugs; 
 (h) Progestin-based drugs; 
 (i) Extended- or continuous-regimen drugs; 
 (j) Estrogen- and progestin-based patches; 
 (k) Vaginal contraceptive rings; 
 (l) Diaphragms with spermicide; 
 (m) Sponges with spermicide; 
 (n) Cervical caps with spermicide; 
 (o) Female condoms; 
 (p) Spermicide; 
 (q) Combined estrogen- and progestin-based drugs for 
emergency contraception or progestin-based drugs for emergency 
contraception; and 
 (r) Ulipristal acetate for emergency contraception. 
 [11.] 12.  Except as otherwise provided in this section and 
federal law, a carrier may use medical management techniques, 
including, without limitation, any available clinical evidence, to 
determine the frequency of or treatment relating to any benefit 
required by this section or the type of provider of health care to use 
for such treatment. 
 [12.] 13.  A carrier shall not [use] : 
 (a) Use medical management techniques to require an insured to 
use a method of contraception other than the method prescribed or 
ordered by a provider of health care [.] ; or 
 (b) Require an insured to obtain prior authorization for the 
benefits described in paragraphs (a) and (c) of subsection 1. 
 [13.] 14.  A carrier must provide an accessible, transparent and 
expedited process which is not unduly burdensome by which an 
insured, or the authorized representative of the insured, may request 
an exception relating to any medical management technique used by 
the carrier to obtain any benefit required by this section without a 
higher deductible, copayment or coinsurance. 
 [14.] 15.  As used in this section:   
 	– 50 – 
 
 
- 	82nd Session (2023) 
 (a) “In-network pharmacy” means a pharmacy that has 
entered into a contract with a carrier to provide services to 
insureds through a network plan offered or issued by the carrier. 
 (b) “Medical management technique” means a practice which is 
used to control the cost or utilization of health care services or 
prescription drug use. The term includes, without limitation, the use 
of step therapy, prior authorization or categorizing drugs and 
devices based on cost, type or method of administration. 
 [(b)] (c) “Network plan” means a health benefit plan offered by 
a carrier under which the financing and delivery of medical care, 
including items and services paid for as medical care, are provided, 
in whole or in part, through a defined set of providers under contract 
with the carrier. The term does not include an arrangement for the 
financing of premiums. 
 [(c)] (d) “Provider network contract” means a contract 
between a carrier and a provider of health care or pharmacy 
specifying the rights and responsibilities of the carrier and the 
provider of health care or pharmacy, as applicable, for delivery of 
health care services pursuant to a network plan. 
 (e) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 [(d)] (f) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 17.  NRS 695A.1865 is hereby amended to read as 
follows: 
 695A.1865 1.  Except as otherwise provided in subsection [7,] 
8, a society that offers or issues a benefit contract which provides 
coverage for prescription drugs or devices shall include in the 
contract coverage for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration;  
  (3) Listed in subsection [10;] 11; and 
  (4) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is:   
 	– 51 – 
 
 
- 	82nd Session (2023) 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Listed in subsection [10;] 11; 
 (c) Self-administered hormonal contraceptives dispensed by a 
pharmacist pursuant to NRS 639.28078; 
 (d) Insertion of a device for contraception or removal of such a 
device if the device was inserted while the insured was covered by 
the same benefit contract; 
 (e) Education and counseling relating to the initiation of the use 
of contraception and any necessary follow-up after initiating such 
use; 
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2. A society shall provide coverage for any services listed in 
subsection 1 which are within the authorized scope of practice of a 
pharmacist when such services are provided by a pharmacist who 
is employed by or serves as an independent contractor of an in-
network pharmacy and in accordance with the applicable provider 
network contract. Such coverage must be provided to the same 
extent as if the services were provided by another provider of 
health care, as applicable to the services being provided. The terms 
of the policy must not limit: 
 (a) Coverage for services listed in subsection 1 and provided by 
such a pharmacist to a number of occasions less than the coverage 
for such services when provided by another provider of health 
care. 
 (b) Reimbursement for services listed in subsection 1 and 
provided by such a pharmacist to an amount less than the amount 
reimbursed for similar services provided by a physician, physician 
assistant or advanced practice registered nurse. 
 3. A society must ensure that the benefits required by 
subsection 1 are made available to an insured through a provider of 
health care who participates in the network plan of the society. 
 [3.] 4.  If a covered therapeutic equivalent listed in subsection 1 
is not available or a provider of health care deems a covered 
therapeutic equivalent to be medically inappropriate, an alternate 
therapeutic equivalent prescribed by a provider of health care must 
be covered by the society. 
 [4.] 5.  Except as otherwise provided in subsections [8,] 9 , 10 
and [11,] 12, a society that offers or issues a benefit contract shall 
not: 
 (a) Require an insured to pay a higher deductible, any 
copayment or coinsurance or require a longer waiting period or   
 	– 52 – 
 
 
- 	82nd Session (2023) 
other condition for coverage for any benefit included in the benefit 
contract pursuant to subsection 1; 
 (b) Refuse to issue a benefit contract or cancel a benefit contract 
solely because the person applying for or covered by the contract 
uses or may use any such benefit; 
 (c) Offer or pay any type of material inducement or financial 
incentive to an insured to discourage the insured from obtaining any 
such benefit; 
 (d) Penalize a provider of health care who provides any such 
benefit to an insured, including, without limitation, reducing the 
reimbursement to the provider of health care; 
 (e) Offer or pay any type of material inducement, bonus or other 
financial incentive to a provider of health care to deny, reduce, 
withhold, limit or delay access to any such benefit to an insured; or 
 (f) Impose any other restrictions or delays on the access of an 
insured to any such benefit.  
 [5.] 6.  Coverage pursuant to this section for the covered 
dependent of an insured must be the same as for the insured. 
 [6.] 7.  Except as otherwise provided in subsection [7,] 8, a 
benefit contract subject to the provisions of this chapter that is 
delivered, issued for delivery or renewed on or after January 1, 
[2022,] 2024, has the legal effect of including the coverage required 
by [subsection 1,] this section, and any provision of the contract or 
the renewal which is in conflict with this section is void. 
 [7.] 8.  A society that offers or issues a benefit contract and 
which is affiliated with a religious organization is not required to 
provide the coverage required by subsection 1 if the society objects 
on religious grounds. Such a society shall, before the issuance of a 
benefit contract and before the renewal of such a contract, provide 
to the prospective insured written notice of the coverage that the 
society refuses to provide pursuant to this subsection. 
 [8.] 9.  A society may require an insured to pay a higher 
deductible, copayment or coinsurance for a drug for contraception if 
the insured refuses to accept a therapeutic equivalent of the drug. 
 [9.] 10.  For each of the 18 methods of contraception listed in 
subsection [10] 11 that have been approved by the Food and Drug 
Administration, a benefit contract must include at least one drug or 
device for contraception within each method for which no 
deductible, copayment or coinsurance may be charged to the 
insured, but the society may charge a deductible, copayment or 
coinsurance for any other drug or device that provides the same 
method of contraception. If the society charges a copayment or   
 	– 53 – 
 
 
- 	82nd Session (2023) 
coinsurance for a drug for contraception, the society may only 
require an insured to pay the copayment or coinsurance: 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed. 
 [10.] 11.  The following 18 methods of contraception must be 
covered pursuant to this section: 
 (a) Voluntary sterilization for women; 
 (b) Surgical sterilization implants for women; 
 (c) Implantable rods; 
 (d) Copper-based intrauterine devices; 
 (e) Progesterone-based intrauterine devices; 
 (f) Injections; 
 (g) Combined estrogen- and progestin-based drugs; 
 (h) Progestin-based drugs; 
 (i) Extended- or continuous-regimen drugs; 
 (j) Estrogen- and progestin-based patches; 
 (k) Vaginal contraceptive rings; 
 (l) Diaphragms with spermicide; 
 (m) Sponges with spermicide; 
 (n) Cervical caps with spermicide; 
 (o) Female condoms; 
 (p) Spermicide; 
 (q) Combined estrogen- and progestin-based drugs for 
emergency contraception or progestin-based drugs for emergency 
contraception; and 
 (r) Ulipristal acetate for emergency contraception. 
 [11.] 12.  Except as otherwise provided in this section and 
federal law, a society may use medical management techniques, 
including, without limitation, any available clinical evidence, to 
determine the frequency of or treatment relating to any benefit 
required by this section or the type of provider of health care to use 
for such treatment. 
 [12.] 13.  A society shall not [use] : 
 (a) Use medical management techniques to require an insured to 
use a method of contraception other than the method prescribed or 
ordered by a provider of health care [.] ; or 
 (b) Require an insured to obtain prior authorization for the 
benefits described in paragraphs (a) and (c) of subsection 1. 
 [13.] 14.  A society must provide an accessible, transparent and 
expedited process which is not unduly burdensome by which an 
insured, or the authorized representative of the insured, may request 
an exception relating to any medical management technique used by   
 	– 54 – 
 
 
- 	82nd Session (2023) 
the society to obtain any benefit required by this section without a 
higher deductible, copayment or coinsurance. 
 [14.] 15.  As used in this section: 
 (a) “In-network pharmacy” means a pharmacy that has 
entered into a contract with a society to provide services to 
insureds through a network plan offered or issued by the society. 
 (b) “Medical management technique” means a practice which is 
used to control the cost or utilization of health care services or 
prescription drug use. The term includes, without limitation, the use 
of step therapy, prior authorization or categorizing drugs and 
devices based on cost, type or method of administration. 
 [(b)] (c) “Network plan” means a benefit contract offered by a 
society under which the financing and delivery of medical care, 
including items and services paid for as medical care, are provided, 
in whole or in part, through a defined set of providers under contract 
with the society. The term does not include an arrangement for the 
financing of premiums. 
 [(c)] (d) “Provider network contract” means a contract 
between a society and a provider of health care or pharmacy 
specifying the rights and responsibilities of the society and the 
provider of health care or pharmacy, as applicable, for delivery of 
health care services pursuant to a network plan. 
 (e) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 [(d)] (f) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 18.  NRS 695B.1919 is hereby amended to read as 
follows: 
 695B.1919 1.  Except as otherwise provided in subsection [7,] 
8, an insurer that offers or issues a contract for hospital or medical 
service shall include in the contract coverage for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration;  
  (3) Listed in subsection [11;] 12; and   
 	– 55 – 
 
 
- 	82nd Session (2023) 
  (4) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Listed in subsection [11;] 12; 
 (c) Self-administered hormonal contraceptives dispensed by a 
pharmacist pursuant to NRS 639.28078; 
 (d) Insertion of a device for contraception or removal of such a 
device if the device was inserted while the insured was covered by 
the same contract for hospital or medical service; 
 (e) Education and counseling relating to the initiation of the use 
of contraception and any necessary follow-up after initiating such 
use; 
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2. An insurer shall provide coverage for any services listed in 
subsection 1 which are within the authorized scope of practice of a 
pharmacist when such services are provided by a pharmacist who 
is employed by or serves as an independent contractor of an in-
network pharmacy and in accordance with the applicable provider 
network contract. Such coverage must be provided to the same 
extent as if the services were provided by another provider of 
health care, as applicable to the services being provided. The terms 
of the policy must not limit: 
 (a) Coverage for services listed in subsection 1 and provided by 
such a pharmacist to a number of occasions less than the coverage 
for such services when provided by another provider of health 
care. 
 (b) Reimbursement for services listed in subsection 1 and 
provided by such a pharmacist to an amount less than the amount 
reimbursed for similar services provided by a physician, physician 
assistant or advanced practice registered nurse. 
 3. An insurer that offers or issues a contract for hospital or 
medical services must ensure that the benefits required by 
subsection 1 are made available to an insured through a provider of 
health care who participates in the network plan of the insurer. 
 [3.] 4.  If a covered therapeutic equivalent listed in subsection 1 
is not available or a provider of health care deems a covered 
therapeutic equivalent to be medically inappropriate, an alternate 
therapeutic equivalent prescribed by a provider of health care must 
be covered by the insurer.   
 	– 56 – 
 
 
- 	82nd Session (2023) 
 [4.] 5.  Except as otherwise provided in subsections [9,] 10 , 11 
and [12,] 13, an insurer that offers or issues a contract for hospital or 
medical service shall not: 
 (a) Require an insured to pay a higher deductible, any 
copayment or coinsurance or require a longer waiting period or 
other condition to obtain any benefit included in the contract for 
hospital or medical service pursuant to subsection 1; 
 (b) Refuse to issue a contract for hospital or medical service or 
cancel a contract for hospital or medical service solely because the 
person applying for or covered by the contract uses or may use any 
such benefit; 
 (c) Offer or pay any type of material inducement or financial 
incentive to an insured to discourage the insured from obtaining any 
such benefit; 
 (d) Penalize a provider of health care who provides any such 
benefit to an insured, including, without limitation, reducing the 
reimbursement to the provider of health care;  
 (e) Offer or pay any type of material inducement, bonus or other 
financial incentive to a provider of health care to deny, reduce, 
withhold, limit or delay access to any such benefit to an insured; or 
 (f) Impose any other restrictions or delays on the access of an 
insured to any such benefit.  
 [5.] 6.  Coverage pursuant to this section for the covered 
dependent of an insured must be the same as for the insured. 
 [6.] 7.  Except as otherwise provided in subsection [7,] 8, a 
contract for hospital or medical service subject to the provisions of 
this chapter that is delivered, issued for delivery or renewed on or 
after January 1, [2022,] 2024, has the legal effect of including the 
coverage required by [subsection 1,] this section, and any provision 
of the contract or the renewal which is in conflict with this section is 
void. 
 [7.] 8.  An insurer that offers or issues a contract for hospital or 
medical service and which is affiliated with a religious organization 
is not required to provide the coverage required by subsection 1 if 
the insurer objects on religious grounds. Such an insurer shall, 
before the issuance of a contract for hospital or medical service and 
before the renewal of such a contract, provide to the prospective 
insured written notice of the coverage that the insurer refuses to 
provide pursuant to this subsection. 
 [8.] 9.  If an insurer refuses, pursuant to subsection [7,] 8, to 
provide the coverage required by subsection 1, an employer may 
otherwise provide for the coverage for the employees of the 
employer.   
 	– 57 – 
 
 
- 	82nd Session (2023) 
 [9.] 10.  An insurer may require an insured to pay a higher 
deductible, copayment or coinsurance for a drug for contraception if 
the insured refuses to accept a therapeutic equivalent of the drug. 
 [10.] 11.  For each of the 18 methods of contraception listed in 
subsection [11] 12 that have been approved by the Food and Drug 
Administration, a contract for hospital or medical service must 
include at least one drug or device for contraception within each 
method for which no deductible, copayment or coinsurance may be 
charged to the insured, but the insurer may charge a deductible, 
copayment or coinsurance for any other drug or device that provides 
the same method of contraception. If the insurer charges a 
copayment or coinsurance for a drug for contraception, the 
insurer may only require an insured to pay the copayment or 
coinsurance: 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed. 
 [11.] 12.  The following 18 methods of contraception must be 
covered pursuant to this section: 
 (a) Voluntary sterilization for women; 
 (b) Surgical sterilization implants for women; 
 (c) Implantable rods; 
 (d) Copper-based intrauterine devices; 
 (e) Progesterone-based intrauterine devices; 
 (f) Injections; 
 (g) Combined estrogen- and progestin-based drugs; 
 (h) Progestin-based drugs; 
 (i) Extended- or continuous-regimen drugs; 
 (j) Estrogen- and progestin-based patches; 
 (k) Vaginal contraceptive rings; 
 (l) Diaphragms with spermicide; 
 (m) Sponges with spermicide; 
 (n) Cervical caps with spermicide; 
 (o) Female condoms; 
 (p) Spermicide; 
 (q) Combined estrogen- and progestin-based drugs for 
emergency contraception or progestin-based drugs for emergency 
contraception; and 
 (r) Ulipristal acetate for emergency contraception. 
 [12.] 13.  Except as otherwise provided in this section and 
federal law, an insurer that offers or issues a contract for hospital or 
medical services may use medical management techniques, 
including, without limitation, any available clinical evidence, to   
 	– 58 – 
 
 
- 	82nd Session (2023) 
determine the frequency of or treatment relating to any benefit 
required by this section or the type of provider of health care to use 
for such treatment. 
 [13.] 14.  An insurer shall not [use] : 
 (a) Use medical management techniques to require an insured to 
use a method of contraception other than the method prescribed or 
ordered by a provider of health care [.] ; or 
 (b) Require an insured to obtain prior authorization for the 
benefits described in paragraphs (a) and (c) of subsection 1. 
 [14.] 15.  An insurer must provide an accessible, transparent 
and expedited process which is not unduly burdensome by which an 
insured, or the authorized representative of the insured, may request 
an exception relating to any medical management technique used by 
the insurer to obtain any benefit required by this section without a 
higher deductible, copayment or coinsurance. 
 [15.] 16.  As used in this section: 
 (a) “In-network pharmacy” means a pharmacy that has 
entered into a contract with an insurer to provide services to 
insureds through a network plan offered or issued by the insurer. 
 (b) “Medical management technique” means a practice which is 
used to control the cost or utilization of health care services or 
prescription drug use. The term includes, without limitation, the use 
of step therapy, prior authorization or categorizing drugs and 
devices based on cost, type or method of administration. 
 [(b)] (c) “Network plan” means a contract for hospital or 
medical service offered by an insurer under which the financing and 
delivery of medical care, including items and services paid for as 
medical care, are provided, in whole or in part, through a defined set 
of providers under contract with the insurer. The term does not 
include an arrangement for the financing of premiums. 
 [(c)] (d) “Provider network contract” means a contract 
between an insurer and a provider of health care or pharmacy 
specifying the rights and responsibilities of the insurer and the 
provider of health care or pharmacy, as applicable, for delivery of 
health care services pursuant to a network plan. 
 (e) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 [(d)] (f) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug;   
 	– 59 – 
 
 
- 	82nd Session (2023) 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 19.  NRS 695C.1696 is hereby amended to read as 
follows: 
 695C.1696 1.  Except as otherwise provided in subsection [7,] 
8, a health maintenance organization that offers or issues a health 
care plan shall include in the plan coverage for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration;  
  (3) Listed in subsection [11;] 12; and 
  (4) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Listed in subsection [11;] 12; 
 (c) Self-administered hormonal contraceptives dispensed by a 
pharmacist pursuant to NRS 639.28078; 
 (d) Insertion of a device for contraception or removal of such a 
device if the device was inserted while the enrollee was covered by 
the same health care plan; 
 (e) Education and counseling relating to the initiation of the use 
of contraception and any necessary follow-up after initiating such 
use; 
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2.  A health maintenance organization shall provide coverage 
for any services listed in subsection 1 which are within the 
authorized scope of practice of a pharmacist when such services 
are provided by a pharmacist who is employed by or serves as an 
independent contractor of an in-network pharmacy and in 
accordance with the applicable provider network contract. Such 
coverage must be provided to the same extent as if the services 
were provided by another provider of health care, as applicable to 
the services being provided. The terms of the policy must not limit: 
 (a) Coverage for services listed in subsection 1 and provided by 
such a pharmacist to a number of occasions less than the coverage 
for such services when provided by another provider of health 
care.   
 	– 60 – 
 
 
- 	82nd Session (2023) 
 (b) Reimbursement for services listed in subsection 1 and 
provided by such a pharmacist to an amount less than the amount 
reimbursed for similar services provided by a physician, physician 
assistant or advanced practice registered nurse. 
 3. A health maintenance organization must ensure that the 
benefits required by subsection 1 are made available to an enrollee 
through a provider of health care who participates in the network 
plan of the health maintenance organization. 
 [3.] 4.  If a covered therapeutic equivalent listed in subsection 1 
is not available or a provider of health care deems a covered 
therapeutic equivalent to be medically inappropriate, an alternate 
therapeutic equivalent prescribed by a provider of health care must 
be covered by the health maintenance organization. 
 [4.] 5.  Except as otherwise provided in subsections [9,] 10 , 11 
and [12,] 13, a health maintenance organization that offers or issues 
a health care plan shall not: 
 (a) Require an enrollee to pay a higher deductible, any 
copayment or coinsurance or require a longer waiting period or 
other condition to obtain any benefit included in the health care plan 
pursuant to subsection 1; 
 (b) Refuse to issue a health care plan or cancel a health care plan 
solely because the person applying for or covered by the plan uses 
or may use any such benefit; 
 (c) Offer or pay any type of material inducement or financial 
incentive to an enrollee to discourage the enrollee from obtaining 
any such benefit; 
 (d) Penalize a provider of health care who provides any such 
benefit to an enrollee, including, without limitation, reducing the 
reimbursement of the provider of health care; 
 (e) Offer or pay any type of material inducement, bonus or other 
financial incentive to a provider of health care to deny, reduce, 
withhold, limit or delay access to any such benefit to an enrollee; or 
 (f) Impose any other restrictions or delays on the access of an 
enrollee to any such benefit.  
 [5.] 6.  Coverage pursuant to this section for the covered 
dependent of an enrollee must be the same as for the enrollee. 
 [6.] 7.  Except as otherwise provided in subsection [7,] 8, a 
health care plan subject to the provisions of this chapter that is 
delivered, issued for delivery or renewed on or after January 1, 
[2022,] 2024, has the legal effect of including the coverage required 
by [subsection 1,] this section, and any provision of the plan or the 
renewal which is in conflict with this section is void.   
 	– 61 – 
 
 
- 	82nd Session (2023) 
 [7.] 8.  A health maintenance organization that offers or issues 
a health care plan and which is affiliated with a religious 
organization is not required to provide the coverage required by 
subsection 1 if the health maintenance organization objects on 
religious grounds. Such an organization shall, before the issuance of 
a health care plan and before the renewal of such a plan, provide to 
the prospective enrollee written notice of the coverage that the 
health maintenance organization refuses to provide pursuant to this 
subsection. 
 [8.] 9.  If a health maintenance organization refuses, pursuant 
to subsection [7,] 8, to provide the coverage required by subsection 
1, an employer may otherwise provide for the coverage for the 
employees of the employer. 
 [9.] 10.  A health maintenance organization may require an 
enrollee to pay a higher deductible, copayment or coinsurance for a 
drug for contraception if the enrollee refuses to accept a therapeutic 
equivalent of the drug.  
 [10.] 11.  For each of the 18 methods of contraception listed in 
subsection [11] 12 that have been approved by the Food and Drug 
Administration, a health care plan must include at least one drug or 
device for contraception within each method for which no 
deductible, copayment or coinsurance may be charged to the 
enrollee, but the health maintenance organization may charge a 
deductible, copayment or coinsurance for any other drug or device 
that provides the same method of contraception. If the health 
maintenance organization charges a copayment or coinsurance 
for a drug for contraception, the health maintenance organization 
may only require an enrollee to pay the copayment or 
coinsurance: 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed. 
 [11.] 12.  The following 18 methods of contraception must be 
covered pursuant to this section: 
 (a) Voluntary sterilization for women; 
 (b) Surgical sterilization implants for women; 
 (c) Implantable rods; 
 (d) Copper-based intrauterine devices; 
 (e) Progesterone-based intrauterine devices; 
 (f) Injections; 
 (g) Combined estrogen- and progestin-based drugs; 
 (h) Progestin-based drugs; 
 (i) Extended- or continuous-regimen drugs;   
 	– 62 – 
 
 
- 	82nd Session (2023) 
 (j) Estrogen- and progestin-based patches; 
 (k) Vaginal contraceptive rings; 
 (l) Diaphragms with spermicide; 
 (m) Sponges with spermicide; 
 (n) Cervical caps with spermicide; 
 (o) Female condoms; 
 (p) Spermicide; 
 (q) Combined estrogen- and progestin-based drugs for 
emergency contraception or progestin-based drugs for emergency 
contraception; and 
 (r) Ulipristal acetate for emergency contraception. 
 [12.] 13.  Except as otherwise provided in this section and 
federal law, a health maintenance organization may use medical 
management techniques, including, without limitation, any available 
clinical evidence, to determine the frequency of or treatment relating 
to any benefit required by this section or the type of provider of 
health care to use for such treatment. 
 [13.] 14.  A health maintenance organization shall not [use] : 
 (a) Use medical management techniques to require an enrollee 
to use a method of contraception other than the method prescribed 
or ordered by a provider of health care [.] ; or 
 (b) Require an enrollee to obtain prior authorization for the 
benefits described in paragraphs (a) and (c) of subsection 1. 
 [14.] 15.  A health maintenance organization must provide an 
accessible, transparent and expedited process which is not unduly 
burdensome by which an enrollee, or the authorized representative 
of the enrollee, may request an exception relating to any medical 
management technique used by the health maintenance organization 
to obtain any benefit required by this section without a higher 
deductible, copayment or coinsurance. 
 [15.] 16.  As used in this section: 
 (a) “In-network pharmacy” means a pharmacy that has 
entered into a contract with a health maintenance organization to 
provide services to enrollees through a network plan offered or 
issued by the health maintenance organization. 
 (b) “Medical management technique” means a practice which is 
used to control the cost or utilization of health care services or 
prescription drug use. The term includes, without limitation, the use 
of step therapy, prior authorization or categorizing drugs and 
devices based on cost, type or method of administration. 
 [(b)] (c) “Network plan” means a health care plan offered by a 
health maintenance organization under which the financing and 
delivery of medical care, including items and services paid for as   
 	– 63 – 
 
 
- 	82nd Session (2023) 
medical care, are provided, in whole or in part, through a defined set 
of providers under contract with the health maintenance 
organization. The term does not include an arrangement for the 
financing of premiums. 
 [(c)] (d) “Provider network contract” means a contract 
between a health maintenance organization and a provider of 
health care or pharmacy specifying the rights and responsibilities 
of the health maintenance organization and the provider of health 
care or pharmacy, as applicable, for delivery of health care 
services pursuant to a network plan.  
 (e) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 [(d)] (f) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 20.  NRS 695G.1715 is hereby amended to read as 
follows: 
 695G.1715 1.  Except as otherwise provided in subsection [7,] 
8, a managed care organization that offers or issues a health care 
plan shall include in the plan coverage for: 
 (a) Up to a 12-month supply, per prescription, of any type of 
drug for contraception or its therapeutic equivalent which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration;  
  (3) Listed in subsection [10;] 11; and 
  (4) Dispensed in accordance with NRS 639.28075; 
 (b) Any type of device for contraception which is: 
  (1) Lawfully prescribed or ordered; 
  (2) Approved by the Food and Drug Administration; and 
  (3) Listed in subsection [10;] 11; 
 (c) Self-administered hormonal contraceptives dispenses by a 
pharmacist pursuant to NRS 639.28078; 
 (d) Insertion of a device for contraception or removal of such a 
device if the device was inserted while the insured was covered by 
the same health care plan;   
 	– 64 – 
 
 
- 	82nd Session (2023) 
 (e) Education and counseling relating to the initiation of the use 
of contraception and any necessary follow-up after initiating such 
use; 
 (f) Management of side effects relating to contraception; and 
 (g) Voluntary sterilization for women. 
 2. A managed care organization shall provide coverage for 
any services listed in subsection 1 which are within the authorized 
scope of practice of a pharmacist when such services are provided 
by a pharmacist who is employed by or serves as an independent 
contractor of an in-network pharmacy and in accordance with the 
applicable provider network contract. Such coverage must be 
provided to the same extent as if the services were provided by 
another provider of health care, as applicable to the services being 
provided. The terms of the policy must not limit: 
 (a) Coverage for services listed in subsection 1 and provided by 
such a pharmacist to a number of occasions less than the coverage 
for such services when provided by another provider of health 
care. 
 (b) Reimbursement for services listed in subsection 1 and 
provided by such a pharmacist to an amount less than the amount 
reimbursed for similar services provided by a physician, physician 
assistant or advanced practice registered nurse. 
 3. A managed care organization must ensure that the benefits 
required by subsection 1 are made available to an insured through a 
provider of health care who participates in the network plan of the 
managed care organization. 
 [3.] 4.  If a covered therapeutic equivalent listed in subsection 1 
is not available or a provider of health care deems a covered 
therapeutic equivalent to be medically inappropriate, an alternate 
therapeutic equivalent prescribed by a provider of health care must 
be covered by the managed care organization. 
 [4.] 5.  Except as otherwise provided in subsections [8,] 9 , 10 
and [11,] 12, a managed care organization that offers or issues a 
health care plan shall not: 
 (a) Require an insured to pay a higher deductible, any 
copayment or coinsurance or require a longer waiting period or 
other condition to obtain any benefit included in the health care plan 
pursuant to subsection 1; 
 (b) Refuse to issue a health care plan or cancel a health care plan 
solely because the person applying for or covered by the plan uses 
or may use any such benefits;   
 	– 65 – 
 
 
- 	82nd Session (2023) 
 (c) Offer or pay any type of material inducement or financial 
incentive to an insured to discourage the insured from obtaining any 
such benefits; 
 (d) Penalize a provider of health care who provides any such 
benefits to an insured, including, without limitation, reducing the 
reimbursement of the provider of health care;  
 (e) Offer or pay any type of material inducement, bonus or other 
financial incentive to a provider of health care to deny, reduce, 
withhold, limit or delay access to any such benefits to an insured; or 
 (f) Impose any other restrictions or delays on the access of an 
insured to any such benefits.  
 [5.] 6.  Coverage pursuant to this section for the covered 
dependent of an insured must be the same as for the insured. 
 [6.] 7.  Except as otherwise provided in subsection [7,] 8, a 
health care plan subject to the provisions of this chapter that is 
delivered, issued for delivery or renewed on or after January 1, 
[2022,] 2024, has the legal effect of including the coverage required 
by [subsection 1,] this section, and any provision of the plan or the 
renewal which is in conflict with this section is void. 
 [7.] 8.  A managed care organization that offers or issues a 
health care plan and which is affiliated with a religious organization 
is not required to provide the coverage required by subsection 1 if 
the managed care organization objects on religious grounds. Such an 
organization shall, before the issuance of a health care plan and 
before the renewal of such a plan, provide to the prospective insured 
written notice of the coverage that the managed care organization 
refuses to provide pursuant to this subsection. 
 [8.] 9.  A managed care organization may require an insured to 
pay a higher deductible, copayment or coinsurance for a drug for 
contraception if the insured refuses to accept a therapeutic 
equivalent of the drug. 
 [9.] 10.  For each of the 18 methods of contraception listed in 
subsection [10] 11 that have been approved by the Food and Drug 
Administration, a health care plan must include at least one drug or 
device for contraception within each method for which no 
deductible, copayment or coinsurance may be charged to the 
insured, but the managed care organization may charge a deductible, 
copayment or coinsurance for any other drug or device that provides 
the same method of contraception. If the managed care 
organization charges a copayment or coinsurance for a drug for 
contraception, the managed care organization may only require 
an enrollee to pay the copayment or coinsurance:   
 	– 66 – 
 
 
- 	82nd Session (2023) 
 (a) Once for the entire amount of the drug dispensed for the 
plan year; or 
 (b) Once for each 1-month supply of the drug dispensed. 
 [10.] 11.  The following 18 methods of contraception must be 
covered pursuant to this section: 
 (a) Voluntary sterilization for women; 
 (b) Surgical sterilization implants for women; 
 (c) Implantable rods; 
 (d) Copper-based intrauterine devices; 
 (e) Progesterone-based intrauterine devices; 
 (f) Injections; 
 (g) Combined estrogen- and progestin-based drugs; 
 (h) Progestin-based drugs; 
 (i) Extended- or continuous-regimen drugs; 
 (j) Estrogen- and progestin-based patches; 
 (k) Vaginal contraceptive rings; 
 (l) Diaphragms with spermicide; 
 (m) Sponges with spermicide; 
 (n) Cervical caps with spermicide; 
 (o) Female condoms; 
 (p) Spermicide; 
 (q) Combined estrogen- and progestin-based drugs for 
emergency contraception or progestin-based drugs for emergency 
contraception; and 
 (r) Ulipristal acetate for emergency contraception. 
 [11.] 12.  Except as otherwise provided in this section and 
federal law, a managed care organization may use medical 
management techniques, including, without limitation, any available 
clinical evidence, to determine the frequency of or treatment relating 
to any benefit required by this section or the type of provider of 
health care to use for such treatment. 
 [12.] 13.  A managed care organization shall not [use] : 
 (a) Use medical management techniques to require an insured to 
use a method of contraception other than the method prescribed or 
ordered by a provider of health care [.] ; or 
 (b) Require an insured to obtain prior authorization for the 
benefits described in paragraphs (a) and (c) of subsection 1. 
 [13.] 14.  A managed care organization must provide an 
accessible, transparent and expedited process which is not unduly 
burdensome by which an insured, or the authorized representative of 
the insured, may request an exception relating to any medical 
management technique used by the managed care organization to   
 	– 67 – 
 
 
- 	82nd Session (2023) 
obtain any benefit required by this section without a higher 
deductible, copayment or coinsurance. 
 [14.] 15.  As used in this section: 
 (a) “In-network pharmacy” means a pharmacy that has 
entered into a contract with a managed care organization to 
provide services to insureds through a network plan offered or 
issued by the managed care organization. 
 (b) “Medical management technique” means a practice which is 
used to control the cost or utilization of health care services or 
prescription drug use. The term includes, without limitation, the use 
of step therapy, prior authorization or categorizing drugs and 
devices based on cost, type or method of administration. 
 [(b)] (c) “Network plan” means a health care plan offered by a 
managed care organization under which the financing and delivery 
of medical care, including items and services paid for as medical 
care, are provided, in whole or in part, through a defined set of 
providers under contract with the managed care organization. The 
term does not include an arrangement for the financing of 
premiums. 
 [(c)] (d) “Provider network contract” means a contract 
between a managed care organization and a provider of health 
care or pharmacy specifying the rights and responsibilities of the 
managed care organization and the provider of health care or 
pharmacy, as applicable, for delivery of health care services 
pursuant to a network plan. 
 (e) “Provider of health care” has the meaning ascribed to it in 
NRS 629.031. 
 [(d)] (f) “Therapeutic equivalent” means a drug which: 
  (1) Contains an identical amount of the same active 
ingredients in the same dosage and method of administration as 
another drug; 
  (2) Is expected to have the same clinical effect when 
administered to a patient pursuant to a prescription or order as 
another drug; and 
  (3) Meets any other criteria required by the Food and Drug 
Administration for classification as a therapeutic equivalent. 
 Sec. 21.  1. The provisions of NRS 422.4053, as amended by 
section 2 of this act, do not apply to a contract between the 
Department of Health and Human Services and a pharmacy benefit 
manager or a health maintenance organization entered into pursuant 
to NRS 422.4053 before January 1, 2024, but do apply to any 
renewal or extension of such a contract. 
 2. As used in this section:   
 	– 68 – 
 
 
- 	82nd Session (2023) 
 (a) “Health maintenance organization” has the meaning ascribed 
to it in NRS 695C.030. 
 (b) “Pharmacy benefit manager” has the meaning ascribed to it 
in NRS 683A.174. 
 Sec. 22.  The provisions of NRS 354.599 do not apply to any 
additional expenses of a local government that are related to the 
provisions of this act. 
 Sec. 23.  1. This section and sections 4 and 5 of this act 
become effective upon passage and approval. 
 2.  Sections 1, 2, 3 and 6 to 22, inclusive, of this act become 
effective: 
 (a) Upon passage and approval for the purpose of performing 
any preparatory administrative tasks that are necessary to carry out 
the provisions of this act; and 
 (b) On January 1, 2024, for all other purposes. 
 
20 ~~~~~ 23