A.B. 186
- *AB186*
ASSEMBLY BILL NO. 186–ASSEMBLYMEMBER ORENTLICHER
PREFILED FEBRUARY 3, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions governing pharmacists.
(BDR 54-344)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to pharmacy; authorizing a registered pharmacist
to prescribe drugs and devices to treat certain health
conditions; authorizing a registered pharmacist to
administer drugs; authorizing a registered pharmacist to
engage in certain activity relating to laboratories and
laboratory testing; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing law authorizes, under certain conditions, a pharmacist to dispense a 1
self-administered hormonal contraceptive without a prescription and prescribe and 2
dispense a drug for the medication-assisted treatment of opioid use disorder. (NRS 3
639.28078, 639.28079) Section 1 of this bill authorizes a registered pharmacist to 4
prescribe and dispense drugs and devices for the treatment of health conditions that: 5
(1) have been previously diagnosed; (2) are self-limiting; (3) are diagnosed after the 6
performance of certain tests; or (4) threaten the health of the patient. Section 1 7
additionally prohibits a registered pharmacist from prescribing drugs and devices 8
not approved by the United States Food and Drug Administration. Section 1 also 9
authorizes the State Board of Pharmacy to adopt regulations establishing: (1) the 10
scope of the ability of a registered pharmacist to prescribe drugs and devices; (2) 11
the standard of care required of a registered pharmacist who prescribes drugs and 12
devices; and (3) the requirements for adequate liability insurance for registered 13
pharmacists who engage in such activities. Section 2 of this bill provides that 14
prescribing and dispensing drugs and devices pursuant to section 1 constitutes the 15
practice of pharmacy. Sections 3, 10-13 and 15 of this bill make additional changes 16
necessary to authorize a registered pharmacist to prescribe and dispense drugs and 17
devices pursuant to section 1. The Board would be authorized to suspend or revoke 18
the registration of a pharmacist who prescribes or dispenses a drug or device 19
without complying with the provisions of section 1 or the regulations adopted 20
pursuant thereto. (NRS 639.210) 21
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Existing law includes within the practice of pharmacy the performance or 22
supervision of activities associated with manufacturing, compounding, labeling, 23
dispensing and distributing a drug. (NRS 629.0124) Section 2 additionally includes 24
the performance or supervision of activities associated with administering a drug, 25
thereby authorizing a registered pharmacist to perform or supervise such activities. 26
Sections 14, 16 and 17 of this bill accordingly provide general authorization for a 27
registered pharmacist to possess and administer controlled substances and 28
dangerous drugs. 29
Existing law requires the Board to adopt regulations governing the 30
manipulation of a person for the collection of specimens by a registered pharmacist 31
that: (1) require the pharmacist to use only a fingerstick or oral or nasal swab to 32
collect the specimens; and (2) set forth the procedures and requirements the 33
pharmacist is required to follow when manipulating a person for the collection of a 34
specimen. (NRS 639.0747) Section 4 of this bill removes the requirement that a 35
pharmacist use only a fingerstick or oral or nasal swab to collect a specimen, 36
thereby authorizing a pharmacist to collect a specimen using any method available 37
for the collection of the specimen. 38
Existing law authorizes a registered pharmacist or a registered intern 39
pharmacist to: (1) perform a home blood glucose test; and (2) order and perform 40
laboratory tests that are necessary for therapy that uses a drug approved by the 41
United States Food and Drug Administration for preventing the acquisition of 42
human immunodeficiency virus. (NRS 639.2808, 639.28085) Section 5 of this bill 43
additionally authorizes a registered pharmacist to: (1) order laboratory tests that are 44
necessary for any drug therapy or that otherwise facilitate the care of a patient 45
within the authorized scope of practice of the pharmacist; and (2) perform certain 46
other laboratory tests determined by the Federal Government to be simple 47
laboratory examinations and procedures that have an insignificant risk of an 48
erroneous result. (42 U.S.C. 263a(d)(3); 42 C.F.R. Part 493, Subpart A) Section 5 49
also authorizes the State Board of Pharmacy to adopt regulations to authorize 50
registered intern pharmacists to order and perform such laboratory tests. Section 2 51
provides that ordering and performing such laboratory tests constitutes the practice 52
of pharmacy. Sections 2 and 6 of this bill remove duplicative provisions from 53
existing law. Sections 8, 9 and 18-24 of this bill make conforming changes so that 54
requirements for insurance coverage of certain services performed by registered 55
pharmacists are not changed by this bill. 56
Existing law requires the State Board of Health to adopt regulations for the 57
certification and licensure of laboratory directors. (NRS 652.125) Existing 58
regulations define an exempt laboratory to be a laboratory that: (1) conducts only 59
certain microscopy tests and tests determined by the Federal Government to be 60
simple laboratory examinations and procedures that have an insignificant risk of an 61
erroneous result; and (2) does not perform only tests for human immunodeficiency 62
virus. (42 U.S.C. 263a(d)(3); 42 C.F.R. Part 493, Subpart A; NAC 652.072) 63
Section 7 of this bill requires regulations of the Board to authorize a registered 64
pharmacist to serve as the laboratory director of an exempt laboratory. 65
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 639 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. Subject to the limitations set forth in subsection 2, a 3
registered pharmacist may, in accordance with any requirements 4
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prescribed pursuant to subsection 3, prescribe drugs or devices 1
that are used for the treatment of health conditions, other than 2
opioid use disorder, that: 3
(a) Have been previously diagnosed; 4
(b) Are self-limiting; 5
(c) Are diagnosed after performing a test that is classified as a 6
waived test pursuant to 42 C.F.R. Part 493, Subpart A; or 7
(d) In the professional judgment of the pharmacist, are 8
emergencies that threaten the health of the patient. 9
2. A registered pharmacist shall not prescribe a drug or 10
device that is not approved by the United States Food and Drug 11
Administration. 12
3. The Board may adopt regulations: 13
(a) Requiring a registered pharmacist who takes the actions 14
authorized by this section to be covered by adequate liability 15
insurance, as determined by the Board; 16
(b) Establishing the scope of the ability for a registered 17
pharmacist to prescribe drugs and devices as authorized by 18
subsection 1; and 19
(c) Establishing the standard of care required of a registered 20
pharmacist who prescribes drugs and devices as authorized by 21
subsection 1. 22
4. As used in this section, “self-limiting” means a health 23
condition that generally persists for a limited period of time. 24
Sec. 2. NRS 639.0124 is hereby amended to read as follows: 25
639.0124 1. “Practice of pharmacy” includes, but is not 26
limited to, the: 27
(a) Performance or supervision of activities associated with 28
manufacturing, compounding, labeling, dispensing , [and] 29
distributing [of] and administering a drug, including the receipt, 30
handling and storage of prescriptions and other confidential 31
information relating to patients. 32
(b) Interpretation and evaluation of prescriptions or orders for 33
medicine. 34
(c) Participation in drug evaluation and drug research. 35
(d) Advising of the therapeutic value, reaction, drug interaction, 36
hazard and use of a drug. 37
(e) Selection of the source, storage and distribution of a drug. 38
(f) Maintenance of proper documentation of the source, storage 39
and distribution of a drug. 40
(g) Interpretation of clinical data contained in a person’s record 41
of medication. 42
(h) Development of written guidelines and protocols in 43
collaboration with a practitioner which authorize collaborative drug 44
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therapy management. The written guidelines and protocols must 1
comply with NRS 639.2629. 2
(i) Implementation and modification of drug therapy, 3
administering drugs and ordering and performing tests in 4
accordance with a collaborative practice agreement. 5
(j) Prescribing, dispensing and administering of drugs for 6
preventing the acquisition of human immunodeficiency virus and 7
[ordering and] conducting laboratory tests necessary for therapy that 8
uses such drugs pursuant to the protocol prescribed pursuant to 9
NRS 639.28085. 10
(k) Dispensing a self-administered hormonal contraceptive 11
pursuant to NRS 639.28078. 12
(l) Assessing a patient and prescribing and dispensing a drug for 13
medication-assisted treatment in accordance with NRS 639.28079. 14
(m) Ordering and performing laboratory tests in accordance 15
with NRS 639.2808. 16
(n) Prescribing and dispensing drugs and devices in 17
accordance with section 1 of this act. 18
2. The term does not include the changing of a prescription by 19
a pharmacist or practitioner without the consent of the prescribing 20
practitioner, except as otherwise provided in NRS 639.2583, 21
639.28078 and 639.28085. 22
Sec. 3. NRS 639.0125 is hereby amended to read as follows: 23
639.0125 “Practitioner” means: 24
1. A physician, dentist, veterinarian or podiatric physician who 25
holds a license to practice his or her profession in this State; 26
2. A hospital, pharmacy or other institution licensed, registered 27
or otherwise permitted to distribute, dispense, conduct research with 28
respect to or administer drugs in the course of professional practice 29
or research in this State; 30
3. An advanced practice registered nurse who has been 31
authorized to prescribe controlled substances, poisons, dangerous 32
drugs and devices; 33
4. A physician assistant who: 34
(a) Holds a license issued by the Board of Medical Examiners; 35
and 36
(b) Is authorized by the Board to possess, administer, prescribe 37
or dispense controlled substances, poisons, dangerous drugs or 38
devices under the supervision of a physician as required by chapter 39
630 of NRS; 40
5. A physician assistant who: 41
(a) Holds a license issued by the State Board of Osteopathic 42
Medicine; and 43
(b) Is authorized by the Board to possess, administer, prescribe 44
or dispense controlled substances, poisons, dangerous drugs or 45
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devices under the supervision of an osteopathic physician as 1
required by chapter 633 of NRS; 2
6. An optometrist who is certified by the Nevada State Board 3
of Optometry to prescribe and administer pharmaceutical agents 4
pursuant to NRS 636.288, when the optometrist prescribes or 5
administers pharmaceutical agents within the scope of his or her 6
certification; 7
7. A dental hygienist who: 8
(a) Holds a valid license to practice dental hygiene in this State; 9
(b) Is authorized to prescribe and dispense the dangerous drugs 10
and devices listed in NRS 631.3105 in accordance with the 11
provisions of that section and the regulations adopted pursuant 12
thereto; and 13
(c) Holds a certificate issued pursuant to NRS 639.1374 by the 14
State Board of Pharmacy authorizing him or her to so prescribe; 15
8. A pharmacist who is registered pursuant to NRS 639.28079 16
to prescribe and dispense drugs for medication-assisted treatment [;] 17
or who prescribes drugs or devices in accordance with section 1 of 18
this act; or 19
9. A certified registered nurse anesthetist who orders, 20
prescribes, possesses or administers controlled substances, poisons, 21
dangerous drugs or devices in accordance with NRS 632.2397. 22
Sec. 4. NRS 639.0747 is hereby amended to read as follows: 23
639.0747 [1.] The Board shall adopt such regulations as are 24
necessary to carry out the provisions of NRS 652.210 with regard to 25
a registered pharmacist, including, without limitation, regulations 26
that [: 27
(a) Require a registered pharmacist to use only a fingerstick or 28
oral or nasal swab to collect the specimens pursuant to NRS 29
652.210; and 30
(b) Set] set forth the procedures and requirements with which a 31
registered pharmacist shall comply when manipulating a person for 32
the collection of specimens or performing any laboratory test 33
pursuant to NRS 652.210. 34
[2. As used in this section, “fingerstick” means a procedure in 35
which a finger is pricked with a lancet, small blade or other 36
instrument to obtain a small quantity of blood for any laboratory test 37
pursuant to NRS 652.210.] 38
Sec. 5. NRS 639.2808 is hereby amended to read as follows: 39
639.2808 1. A registered pharmacist [or a] may: 40
(a) Order laboratory tests that are necessary for therapy that 41
uses a drug approved by the Food and Drug Administration or to 42
otherwise facilitate the care of a patient within the authorized 43
scope of practice of the registered pharmacist; and 44
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(b) Perform any laboratory test that is classified as a waived 1
test under 42 C.F.R. Part 493, Subpart A, including, without 2
limitation, a blood glucose test using devices for monitoring 3
approved by the Food and Drug Administration for use in the 4
home if such a test is performed in compliance with standards of 5
practice recommended by the Association of Diabetes Care and 6
Education Specialists. 7
2. A registered intern pharmacist may perform a blood glucose 8
test using devices for monitoring approved by the Food and Drug 9
Administration for use in the home. The performance of such a test 10
must be in compliance with standards of practice recommended by 11
the [American] Association of Diabetes [Educators] Care and 12
Education Specialists or its successor organization. The Board may 13
adopt regulations authorizing a registered intern pharmacist to 14
perform other activities described in subsection 1. 15
Sec. 6. NRS 639.28085 is hereby amended to read as follows: 16
639.28085 1. To the extent authorized by federal law, a 17
pharmacist who meets the requirements prescribed by the Board 18
pursuant to subsection 2 may, in accordance with the requirements 19
of the protocol prescribed pursuant to subsection 2: 20
(a) [Order and perform] Perform laboratory tests that are 21
necessary for therapy that uses a drug approved by the United States 22
Food and Drug Administration for preventing the acquisition of 23
human immunodeficiency virus; and 24
(b) Prescribe, dispense and administer any drug described in 25
paragraph (a) to a patient. 26
2. The Board shall adopt regulations: 27
(a) Requiring a pharmacist who takes the actions authorized by 28
this section to be covered by adequate liability insurance, as 29
determined by the Board; and 30
(b) Establishing a protocol for the actions authorized by this 31
section. 32
Sec. 7. NRS 652.125 is hereby amended to read as follows: 33
652.125 1. The Board shall adopt regulations for the 34
certification and licensure of laboratory directors and laboratory 35
personnel who perform technical duties other than the collection of 36
blood. The regulations must authorize a registered pharmacist to 37
serve as the laboratory director of an exempt laboratory, 38
regardless of whether the registered pharmacist has entered into a 39
collaborative practice agreement. 40
2. The Division shall, as a prerequisite for the renewal of a 41
certificate or license, require the laboratory director and any 42
laboratory personnel certified by the Division pursuant to this 43
chapter to comply with the requirements for continuing education 44
adopted by the Board. 45
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3. As used in this section: 1
(a) “Collaborative practice agreement” has the meaning 2
ascribed to it in NRS 639.0052. 3
(b) “Exempt laboratory” means a laboratory: 4
(1) That is licensed pursuant to this chapter and the 5
regulations adopted pursuant thereto; 6
(2) That does not only perform testing for human 7
immunodeficiency virus; and 8
(3) In which each test performed is: 9
(I) Classified as a waived test pursuant to 42 C.F.R. Part 10
493, Subpart A; or 11
(II) Categorized as a provider-performed microscopy 12
procedure pursuant to 42 C.F.R. § 493.19. 13
Sec. 8. NRS 287.0271 is hereby amended to read as follows: 14
287.0271 1. The governing body of any county, school 15
district, municipal corporation, political subdivision, public 16
corporation or other local governmental agency of the State of 17
Nevada that provides health insurance through a plan of self-18
insurance shall provide coverage for: 19
(a) Drugs approved by the United States Food and Drug 20
Administration for preventing the acquisition of human 21
immunodeficiency virus; 22
(b) Laboratory testing that is necessary for therapy that uses 23
such a drug; and 24
(c) [The] Ordering laboratory testing described in paragraph 25
(b) and the services described in NRS 639.28085, when provided by 26
a pharmacist who participates in the network plan of the governing 27
body. 28
2. The governing body of any county, school district, 29
municipal corporation, political subdivision, public corporation or 30
other local governmental agency of the State of Nevada that 31
provides health insurance through a plan of self-insurance shall 32
reimburse a pharmacist who participates in the network plan of the 33
governing body for the services described in [NRS 639.28085] 34
paragraph (c) of subsection 1 at a rate equal to the rate of 35
reimbursement provided to a physician, physician assistant or 36
advanced practice registered nurse for similar services. 37
3. The governing body of any county, school district, 38
municipal corporation, political subdivision, public corporation or 39
other local governmental agency of the State of Nevada that 40
provides health insurance through a plan of self-insurance may 41
subject the benefits required by subsection 1 to reasonable medical 42
management techniques. 43
4. The governing body of any county, school district, 44
municipal corporation, political subdivision, public corporation or 45
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other local governmental agency of the State of Nevada that 1
provides health insurance through a plan of self-insurance shall 2
ensure that the benefits required by subsection 1 are made available 3
to an insured through a provider of health care who participates in 4
the network plan of the governing body. 5
5. A plan of self-insurance described in subsection 1 that is 6
delivered, issued for delivery or renewed on or after January 1, 7
2024, has the legal effect of including the coverage required by 8
subsection 1, and any provision of the plan that conflicts with the 9
provisions of this section is void. 10
6. As used in this section: 11
(a) “Medical management technique” means a practice which is 12
used to control the cost or use of health care services or prescription 13
drugs. The term includes, without limitation, the use of step therapy, 14
prior authorization and categorizing drugs and devices based on 15
cost, type or method of administration. 16
(b) “Network plan” means a plan of self-insurance provided by 17
the governing body of a local governmental agency under which the 18
financing and delivery of medical care, including items and services 19
paid for as medical care, are provided, in whole or in part, through a 20
defined set of providers under contract with the governing body. 21
The term does not include an arrangement for the financing of 22
premiums. 23
(c) “Provider of health care” has the meaning ascribed to it in 24
NRS 629.031. 25
Sec. 9. NRS 422.27235 is hereby amended to read as follows: 26
422.27235 1. The Director shall include in the State Plan for 27
Medicaid a requirement that the State pay the nonfederal share of 28
expenditures incurred for: 29
(a) Any laboratory testing that is necessary for therapy that uses 30
a drug approved by the United States Food and Drug Administration 31
for preventing the acquisition of human immunodeficiency virus. 32
(b) The ordering of a laboratory test described in paragraph 33
(a) by a pharmacist and the services of a pharmacist described in 34
NRS 639.28085. The State must provide reimbursement for such 35
services at a rate equal to the rate of reimbursement provided to a 36
physician, physician assistant or advanced practice registered nurse 37
for similar services. 38
(c) Any service to test for, prevent or treat human 39
immunodeficiency virus or hepatitis C provided by a provider of 40
primary care if the service is covered when provided by a specialist 41
and: 42
(1) The service is within the scope of practice of the provider 43
of primary care; or 44
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(2) The provider of primary care is capable of providing the 1
service safely and effectively in consultation with a specialist and 2
the provider engages in such consultation. 3
2. The Director shall include in the State Plan for Medicaid a 4
requirement that the State reimburse an advanced practice registered 5
nurse or a physician assistant for any service to test for, prevent or 6
treat human immunodeficiency virus or hepatitis C at a rate equal to 7
the rate of reimbursement provided to a physician for similar 8
services. 9
3. As used in this section, “primary care” means the practice of 10
family medicine, pediatrics, internal medicine, obstetrics and 11
gynecology and midwifery. 12
Sec. 10. NRS 453.126 is hereby amended to read as follows: 13
453.126 “Practitioner” means: 14
1. A physician, dentist, veterinarian or podiatric physician who 15
holds a license to practice his or her profession in this State and is 16
registered pursuant to this chapter. 17
2. An advanced practice registered nurse who holds a 18
certificate from the State Board of Pharmacy authorizing him or her 19
to dispense or to prescribe and dispense controlled substances. 20
3. A scientific investigator or a pharmacy, hospital or other 21
institution licensed, registered or otherwise authorized in this State 22
to distribute, dispense, conduct research with respect to, to 23
administer, or use in teaching or chemical analysis, a controlled 24
substance in the course of professional practice or research. 25
4. A euthanasia technician who is licensed by the Nevada State 26
Board of Veterinary Medical Examiners and registered pursuant to 27
this chapter, while he or she possesses or administers sodium 28
pentobarbital pursuant to his or her license and registration. 29
5. A physician assistant who: 30
(a) Holds a license from the Board of Medical Examiners; and 31
(b) Is authorized by the Board to possess, administer, prescribe 32
or dispense controlled substances under the supervision of a 33
physician as required by chapter 630 of NRS. 34
6. A physician assistant who: 35
(a) Holds a license from the State Board of Osteopathic 36
Medicine; and 37
(b) Is authorized by the Board to possess, administer, prescribe 38
or dispense controlled substances under the supervision of an 39
osteopathic physician as required by chapter 633 of NRS. 40
7. An optometrist who is certified by the Nevada State Board 41
of Optometry to prescribe and administer pharmaceutical agents 42
pursuant to NRS 636.288, when the optometrist prescribes or 43
administers pharmaceutical agents within the scope of his or her 44
certification. 45
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8. A certified registered nurse anesthetist who orders, 1
prescribes, possesses or administers controlled substances in 2
accordance with NRS 632.2397. 3
9. A pharmacist who is registered pursuant to NRS 639.28079 4
to prescribe and dispense drugs for medication-assisted treatment [.] 5
or who prescribes and dispenses drugs or devices in accordance 6
with section 1 of this act. 7
Sec. 11. NRS 453.128 is hereby amended to read as follows: 8
453.128 1. “Prescription” means: 9
(a) An order given individually for the person for whom 10
prescribed, directly from a physician, physician assistant licensed 11
pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, 12
optometrist, advanced practice registered nurse, certified registered 13
nurse anesthetist, pharmacist registered pursuant to NRS 639.28079 14
or acting in accordance with section 1 of this act or veterinarian, or 15
his or her agent, to a pharmacist or indirectly by means of an order 16
signed by the practitioner or an electronic transmission from the 17
practitioner to a pharmacist; or 18
(b) A chart order written for an inpatient specifying drugs which 19
he or she is to take home upon his or her discharge. 20
2. The term does not include a chart order written for an 21
inpatient for use while he or she is an inpatient. 22
Sec. 12. NRS 453.226 is hereby amended to read as follows: 23
453.226 1. Every practitioner or other person who dispenses 24
any controlled substance within this State or who proposes to 25
engage in the dispensing of any controlled substance within this 26
State shall obtain biennially a registration issued by the Board in 27
accordance with its regulations. A person must present proof that he 28
or she is authorized to access the database of the program 29
established pursuant to NRS 453.162 before the Board may issue or 30
renew a registration. 31
2. A person registered by the Board in accordance with the 32
provisions of NRS 453.011 to 453.552, inclusive, to dispense or 33
conduct research with controlled substances may possess, dispense 34
or conduct research with those substances to the extent authorized 35
by the registration and in conformity with the other provisions of 36
those sections. 37
3. The following persons are not required to register and may 38
lawfully possess and distribute controlled substances pursuant to the 39
provisions of NRS 453.011 to 453.552, inclusive: 40
(a) An agent or employee of a registered dispenser of a 41
controlled substance if he or she is acting in the usual course of his 42
or her business or employment; 43
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(b) A common or contract carrier or warehouseman, or an 1
employee thereof, whose possession of any controlled substance is 2
in the usual course of business or employment; 3
(c) An ultimate user or a person in possession of any controlled 4
substance pursuant to a lawful order of a physician, physician 5
assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, 6
advanced practice registered nurse, certified registered nurse 7
anesthetist, podiatric physician, pharmacist registered pursuant to 8
NRS 639.28079 or acting in accordance with section 1 of this act 9
or veterinarian or in lawful possession of a schedule V substance; or 10
(d) A physician who: 11
(1) Holds a locum tenens license issued by the Board of 12
Medical Examiners or a temporary license issued by the State Board 13
of Osteopathic Medicine; and 14
(2) Is registered with the Drug Enforcement Administration 15
at a location outside this State. 16
4. The Board may waive the requirement for registration of 17
certain dispensers if it finds it consistent with the public health and 18
safety. 19
5. A separate registration is required at each principal place of 20
business or professional practice where the applicant dispenses 21
controlled substances. 22
6. The Board may inspect the establishment of a registrant or 23
applicant for registration in accordance with the Board’s regulations. 24
Sec. 13. NRS 453.336 is hereby amended to read as follows: 25
453.336 1. Except as otherwise provided in subsection 6, a 26
person shall not knowingly or intentionally possess a controlled 27
substance, unless the substance was obtained directly from, or 28
pursuant to, a prescription or order of a physician, physician 29
assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, 30
podiatric physician, optometrist, advanced practice registered nurse, 31
certified registered nurse anesthetist, pharmacist registered pursuant 32
to NRS 639.28079 or acting in accordance with section 1 of this 33
act or veterinarian while acting in the course of his or her 34
professional practice, or except as otherwise authorized by the 35
provisions of NRS 453.005 to 453.552, inclusive. 36
2. Except as otherwise provided in subsections 3, 4 and 5 and 37
in NRS 453.3363, and unless a greater penalty is provided in NRS 38
212.160, 453.3385, 453.3387 or 453.339, a person who violates this 39
section: 40
(a) For a first or second offense, if the controlled substance is 41
listed in schedule I or II and the quantity possessed is less than 14 42
grams, or if the controlled substance is listed in schedule III, IV or V 43
and the quantity possessed is less than 28 grams, is guilty of 44
possession of a controlled substance and shall be punished for a 45
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category E felony as provided in NRS 193.130. In accordance with 1
NRS 176.211, the court shall defer judgment upon the consent of the 2
person. 3
(b) For a third or subsequent offense, if the controlled substance 4
is listed in schedule I or II and the quantity possessed is less than 14 5
grams, or if the controlled substance is listed in schedule III, IV or V 6
and the quantity possessed is less than 28 grams, or if the offender 7
has previously been convicted two or more times in the aggregate of 8
any violation of the law of the United States or of any state, territory 9
or district relating to a controlled substance, is guilty of possession 10
of a controlled substance and shall be punished for a category D 11
felony as provided in NRS 193.130, and may be further punished by 12
a fine of not more than $20,000. 13
(c) If the controlled substance is listed in schedule I or II and the 14
quantity possessed is 14 grams or more, but less than 28 grams, or if 15
the controlled substance is listed in schedule III, IV or V and the 16
quantity possessed is 28 grams or more, but less than 200 grams, is 17
guilty of low-level possession of a controlled substance and shall be 18
punished for a category C felony as provided in NRS 193.130. 19
(d) If the controlled substance is listed in schedule I or II and the 20
quantity possessed is 28 grams or more, but less than 42 grams, or if 21
the controlled substance is listed in schedule III, IV or V and the 22
quantity possessed is 200 grams or more, is guilty of mid-level 23
possession of a controlled substance and shall be punished for a 24
category B felony by imprisonment in the state prison for a 25
minimum term of not less than 1 year and a maximum term of not 26
more than 10 years and by a fine of not more than $50,000. 27
(e) If the controlled substance is listed in schedule I or II and the 28
quantity possessed is 42 grams or more, but less than 100 grams, is 29
guilty of high-level possession of a controlled substance and shall be 30
punished for a category B felony by imprisonment in the state prison 31
for a minimum term of not less than 2 years and a maximum term of 32
not more than 15 years and by a fine of not more than $50,000. 33
3. Unless a greater penalty is provided in NRS 212.160, 34
453.337 or 453.3385, a person who is convicted of the possession of 35
flunitrazepam or gamma-hydroxybutyrate, or any substance for 36
which flunitrazepam or gamma-hydroxybutyrate is an immediate 37
precursor, is guilty of a category B felony and shall be punished by 38
imprisonment in the state prison for a minimum term of not less 39
than 1 year and a maximum term of not more than 6 years. 40
4. Unless a greater penalty is provided pursuant to NRS 41
212.160, a person who is convicted of the possession of 1 ounce or 42
less of marijuana is guilty of a misdemeanor and shall be punished 43
by: 44
(a) Performing not more than 24 hours of community service; 45
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(b) Attending the live meeting described in paragraph (a) of 1
subsection 2 of NRS 484C.530 and complying with any other 2
requirements set forth in that section; or 3
(c) Being required to undergo an evaluation in accordance with 4
subsection 1 of NRS 484C.350, 5
or any combination thereof. 6
5. Unless a greater penalty is provided pursuant to NRS 7
212.160, a person who is convicted of the possession of more than 1 8
ounce, but less than 50 pounds, of marijuana or more than one-9
eighth of an ounce, but less than one pound, of concentrated 10
cannabis is guilty of a category E felony and shall be punished as 11
provided in NRS 193.130. 12
6. It is not a violation of this section if a person possesses a 13
trace amount of a controlled substance and that trace amount is in or 14
on a hypodermic device obtained from a sterile hypodermic device 15
program pursuant to NRS 439.985 to 439.994, inclusive. 16
7. The court may grant probation to or suspend the sentence of 17
a person convicted of violating this section. 18
8. If a person fulfills the terms and conditions imposed for a 19
violation of subsection 4, the court shall, without a hearing, order 20
sealed all documents, papers and exhibits in that person’s record, 21
minute book entries and entries on dockets, and other documents 22
relating to the case in the custody of such other agencies and 23
officers as are named in the court’s order. The court shall cause a 24
copy of the order to be sent to each agency or officer named in the 25
order. Each such agency or officer shall notify the court in writing 26
of its compliance with the order. 27
9. As used in this section: 28
(a) “Controlled substance” includes flunitrazepam, gamma-29
hydroxybutyrate and each substance for which flunitrazepam or 30
gamma-hydroxybutyrate is an immediate precursor. 31
(b) “Marijuana” does not include concentrated cannabis. 32
(c) “Sterile hypodermic device program” has the meaning 33
ascribed to it in NRS 439.986. 34
Sec. 14. NRS 453.375 is hereby amended to read as follows: 35
453.375 1. A controlled substance may be possessed and 36
administered by the following persons: 37
(a) A practitioner. 38
(b) A registered nurse licensed to practice professional nursing 39
or licensed practical nurse, at the direction of a physician, physician 40
assistant, dentist, podiatric physician or advanced practice registered 41
nurse, or pursuant to a chart order, for administration to a patient at 42
another location. 43
(c) A paramedic: 44
(1) As authorized by regulation of: 45
– 14 –
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(I) The State Board of Health in a county whose 1
population is less than 100,000; or 2
(II) A county or district board of health in a county whose 3
population is 100,000 or more; and 4
(2) In accordance with any applicable regulations of: 5
(I) The State Board of Health in a county whose 6
population is less than 100,000; 7
(II) A county board of health in a county whose 8
population is 100,000 or more; or 9
(III) A district board of health created pursuant to NRS 10
439.362 or 439.370 in any county. 11
(d) A respiratory therapist, at the direction of a physician or 12
physician assistant. 13
(e) An anesthesiologist assistant, at the direction of a 14
supervising anesthesiologist or supervising osteopathic 15
anesthesiologist. 16
(f) A medical student, student in training to become a physician 17
assistant or anesthesiologist assistant, student nurse in the course of 18
his or her studies at an accredited college of medicine or approved 19
school of professional or practical nursing, at the direction of a 20
physician or physician assistant and: 21
(1) In the presence of a physician, physician assistant or a 22
registered nurse; or 23
(2) Under the supervision of a physician, physician assistant 24
or a registered nurse if the student is authorized by the college or 25
school to administer the substance outside the presence of a 26
physician, physician assistant or nurse. 27
A medical student or student nurse may administer a controlled 28
substance in the presence or under the supervision of a registered 29
nurse alone only if the circumstances are such that the registered 30
nurse would be authorized to administer it personally. 31
(g) An ultimate user or any person whom the ultimate user 32
designates pursuant to a written agreement. 33
(h) Any person designated by the head of a correctional 34
institution. 35
(i) A veterinary technician at the direction of his or her 36
supervising veterinarian. 37
(j) In accordance with applicable regulations of the State Board 38
of Health, an employee of a residential facility for groups, as 39
defined in NRS 449.017, pursuant to a written agreement entered 40
into by the ultimate user. 41
(k) In accordance with applicable regulations of the State Board 42
of Pharmacy, an animal control officer, a wildlife biologist or an 43
employee designated by a federal, state or local governmental 44
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- *AB186*
agency whose duties include the control of domestic, wild and 1
predatory animals. 2
(l) A person who is enrolled in a training program to become a 3
paramedic, respiratory therapist or veterinary technician if the 4
person possesses and administers the controlled substance in the 5
same manner and under the same conditions that apply, respectively, 6
to a paramedic, respiratory therapist or veterinary technician who 7
may possess and administer the controlled substance, and under the 8
direct supervision of a person licensed or registered to perform the 9
respective medical art or a supervisor of such a person. 10
(m) A registered pharmacist . [pursuant to written guidelines and 11
protocols developed pursuant to NRS 639.2629 or a collaborative 12
practice agreement, as defined in NRS 639.0052.] 13
2. As used in this section: 14
(a) “Accredited college of medicine” means: 15
(1) A medical school that is accredited by the Liaison 16
Committee on Medical Education of the American Medical 17
Association and the Association of American Medical Colleges or 18
their successor organizations; or 19
(2) A school of osteopathic medicine, as defined in 20
NRS 633.121. 21
(b) “Anesthesiologist assistant” means a person who holds a 22
license issued pursuant to NRS 630.2683 or 633.4254 or a 23
temporary license issued pursuant to NRS 630.2685 or 633.4262. 24
Sec. 15. NRS 453.381 is hereby amended to read as follows: 25
453.381 1. In addition to the limitations imposed by NRS 26
453.256 and 453.3611 to 453.3648, inclusive, a physician, physician 27
assistant, dentist, advanced practice registered nurse, certified 28
registered nurse anesthetist, podiatric physician or pharmacist 29
registered pursuant to NRS 639.28079 or acting in accordance with 30
section 1 of this act may prescribe or administer controlled 31
substances only for a legitimate medical purpose and in the usual 32
course of his or her professional practice, and he or she shall not 33
prescribe, administer or dispense a controlled substance listed in 34
schedule II for himself or herself, his or her spouse or his or her 35
children except in cases of emergency. 36
2. A veterinarian, in the course of his or her professional 37
practice only, and not for use by a human being, may prescribe, 38
possess and administer controlled substances, and the veterinarian 39
may cause them to be administered by a veterinary technician under 40
the direction and supervision of the veterinarian. 41
3. A euthanasia technician, within the scope of his or her 42
license, and not for use by a human being, may possess and 43
administer sodium pentobarbital. 44
– 16 –
- *AB186*
4. A pharmacist shall not fill an order which purports to be a 1
prescription if the pharmacist has reason to believe that it was not 2
issued in the usual course of the professional practice of a physician, 3
physician assistant, dentist, advanced practice registered nurse, 4
certified registered nurse anesthetist, podiatric physician, pharmacist 5
registered pursuant to NRS 639.28079 or acting in accordance with 6
section 1 of this act or veterinarian. 7
5. Any person who has obtained from a physician, physician 8
assistant, dentist, advanced practice registered nurse, certified 9
registered nurse anesthetist, podiatric physician, pharmacist 10
registered pursuant to NRS 639.28079 or acting in accordance with 11
section 1 of this act or veterinarian any controlled substance for 12
administration to a patient during the absence of the physician, 13
physician assistant, dentist, advanced practice registered nurse, 14
certified registered nurse anesthetist, podiatric physician, pharmacist 15
or veterinarian shall return to him or her any unused portion of the 16
substance when it is no longer required by the patient. 17
6. A manufacturer, wholesale supplier or other person legally 18
able to furnish or sell any controlled substance listed in schedule II 19
shall not provide samples of such a controlled substance to 20
registrants. 21
7. A salesperson of any manufacturer or wholesaler of 22
pharmaceuticals shall not possess, transport or furnish any 23
controlled substance listed in schedule II. 24
8. A person shall not dispense a controlled substance in 25
violation of a regulation adopted by the Board. 26
Sec. 16. NRS 454.00958 is hereby amended to read as 27
follows: 28
454.00958 “Practitioner” means: 29
1. A physician, dentist, veterinarian or podiatric physician who 30
holds a valid license to practice his or her profession in this State. 31
2. A pharmacy, hospital or other institution licensed or 32
registered to distribute, dispense, conduct research with respect to or 33
to administer a dangerous drug in the course of professional practice 34
in this State. 35
3. When relating to the prescription of poisons, dangerous 36
drugs and devices: 37
(a) An advanced practice registered nurse who holds a certificate 38
from the State Board of Pharmacy permitting him or her so to 39
prescribe; or 40
(b) A physician assistant who holds a license from the Board of 41
Medical Examiners and a certificate from the State Board of 42
Pharmacy permitting him or her so to prescribe. 43
4. An optometrist who is certified to prescribe and administer 44
pharmaceutical agents pursuant to NRS 636.288 when the 45
– 17 –
- *AB186*
optometrist prescribes or administers dangerous drugs which are 1
within the scope of his or her certification. 2
5. A dental hygienist who holds a valid license to practice 3
dental hygiene in this State and: 4
(a) Is authorized to prescribe and dispense the dangerous drugs 5
listed in NRS 631.3105 in accordance with the provisions of that 6
section and the regulations adopted pursuant thereto; and 7
(b) Holds a certificate issued by the State Board of Pharmacy 8
pursuant to NRS 639.1374 authorizing him or her to so prescribe. 9
6. A certified registered nurse anesthetist who orders, 10
prescribes, possesses or administers poisons, dangerous drugs or 11
devices in accordance with NRS 632.2397. 12
7. A pharmacist who is registered pursuant to NRS 639.28079 13
to prescribe and dispense drugs for medication-assisted treatment [.] 14
or who prescribes and dispenses drugs or devices in accordance 15
with section 1 of this act. 16
Sec. 17. NRS 454.213 is hereby amended to read as follows: 17
454.213 1. Except as otherwise provided in NRS 454.217, a 18
drug or medicine referred to in NRS 454.181 to 454.371, inclusive, 19
may be possessed and administered by: 20
(a) A practitioner. 21
(b) A physician assistant licensed pursuant to chapter 630 or 633 22
of NRS or an anesthesiologist assistant, at the direction of his or her 23
supervising physician or supervising anesthesiologist or supervising 24
osteopathic anesthesiologist, as applicable, or a licensed dental 25
hygienist or expanded function dental assistant acting in the office 26
of and under the supervision of a dentist. 27
(c) Except as otherwise provided in paragraph (d), a registered 28
nurse licensed to practice professional nursing or licensed practical 29
nurse, at the direction of a prescribing physician, physician assistant 30
licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric 31
physician or advanced practice registered nurse, or pursuant to a 32
chart order, for administration to a patient at another location. 33
(d) In accordance with applicable regulations of the Board, a 34
registered nurse licensed to practice professional nursing or licensed 35
practical nurse who is: 36
(1) Employed by a health care agency or health care facility 37
that is authorized to provide emergency care, or to respond to the 38
immediate needs of a patient, in the residence of the patient; and 39
(2) Acting under the direction of the medical director of that 40
agency or facility who works in this State. 41
(e) A medication aide - certified at a designated facility under 42
the supervision of an advanced practice registered nurse or 43
registered nurse and in accordance with standard protocols 44
developed by the State Board of Nursing. As used in this paragraph, 45
– 18 –
- *AB186*
“designated facility” has the meaning ascribed to it in 1
NRS 632.0145. 2
(f) Except as otherwise provided in paragraph (g), an advanced 3
emergency medical technician or a paramedic, as authorized by 4
regulation of the State Board of Pharmacy and in accordance with 5
any applicable regulations of: 6
(1) The State Board of Health in a county whose population 7
is less than 100,000; 8
(2) A county board of health in a county whose population is 9
100,000 or more; or 10
(3) A district board of health created pursuant to NRS 11
439.362 or 439.370 in any county. 12
(g) An advanced emergency medical technician or a paramedic 13
who holds an endorsement issued pursuant to NRS 450B.1975, 14
under the direct supervision of a local health officer or a designee of 15
the local health officer pursuant to that section. 16
(h) A respiratory therapist employed in a health care facility. 17
The therapist may possess and administer respiratory products only 18
at the direction of a physician. 19
(i) A dialysis technician, under the direction or supervision of a 20
physician or registered nurse only if the drug or medicine is used for 21
the process of renal dialysis. 22
(j) A medical student or student nurse in the course of his or her 23
studies at an accredited college of medicine or approved school of 24
professional or practical nursing, at the direction of a physician and: 25
(1) In the presence of a physician or a registered nurse; or 26
(2) Under the supervision of a physician or a registered nurse 27
if the student is authorized by the college or school to administer the 28
drug or medicine outside the presence of a physician or nurse. 29
A medical student or student nurse may administer a dangerous 30
drug in the presence or under the supervision of a registered nurse 31
alone only if the circumstances are such that the registered nurse 32
would be authorized to administer it personally. 33
(k) Any person designated by the head of a correctional 34
institution. 35
(l) An ultimate user or any person designated by the ultimate 36
user pursuant to a written agreement. 37
(m) A holder of a license to engage in radiation therapy and 38
radiologic imaging issued pursuant to chapter 653 of NRS, at the 39
direction of a physician and in accordance with any conditions 40
established by regulation of the Board. 41
(n) A chiropractic physician, but only if the drug or medicine is 42
a topical drug used for cooling and stretching external tissue during 43
therapeutic treatments. 44
– 19 –
- *AB186*
(o) A physical therapist, but only if the drug or medicine is a 1
topical drug which is: 2
(1) Used for cooling and stretching external tissue during 3
therapeutic treatments; and 4
(2) Prescribed by a licensed physician for: 5
(I) Iontophoresis; or 6
(II) The transmission of drugs through the skin using 7
ultrasound. 8
(p) In accordance with applicable regulations of the State Board 9
of Health, an employee of a residential facility for groups, as 10
defined in NRS 449.017, pursuant to a written agreement entered 11
into by the ultimate user. 12
(q) A veterinary technician or a veterinary assistant at the 13
direction of his or her supervising veterinarian. 14
(r) [In accordance with applicable regulations of the Board, a 15
registered pharmacist who: 16
(1) Is trained in and certified to carry out standards and 17
practices for immunization programs; 18
(2) Is authorized to administer immunizations pursuant to 19
written protocols from a physician; and 20
(3) Administers immunizations in compliance with the 21
“Standards for Immunization Practices” recommended and 22
approved by the Advisory Committee on Immunization Practices of 23
the Centers for Disease Control and Prevention. 24
(s)] A registered pharmacist . [pursuant to written guidelines and 25
protocols developed pursuant to NRS 639.2629 or a collaborative 26
practice agreement, as defined in NRS 639.0052. 27
(t)] (s) A person who is enrolled in a training program to 28
become a physician assistant or anesthesiologist assistant licensed 29
pursuant to chapter 630 or 633 of NRS, dental hygienist, advanced 30
emergency medical technician, paramedic, respiratory therapist, 31
dialysis technician, physical therapist or veterinary technician or to 32
obtain a license to engage in radiation therapy and radiologic 33
imaging pursuant to chapter 653 of NRS if the person possesses and 34
administers the drug or medicine in the same manner and under the 35
same conditions that apply, respectively, to a physician assistant or 36
anesthesiologist assistant licensed pursuant to chapter 630 or 633 of 37
NRS, dental hygienist, advanced emergency medical technician, 38
paramedic, respiratory therapist, dialysis technician, physical 39
therapist, veterinary technician or person licensed to engage in 40
radiation therapy and radiologic imaging who may possess and 41
administer the drug or medicine, and under the direct supervision of 42
a person licensed or registered to perform the respective medical art 43
or a supervisor of such a person. 44
– 20 –
- *AB186*
[(u)] (t) A medical assistant, in accordance with applicable 1
regulations of the: 2
(1) Board of Medical Examiners, at the direction of the 3
prescribing physician and under the supervision of a physician or 4
physician assistant. 5
(2) State Board of Osteopathic Medicine, at the direction of 6
the prescribing physician and under the supervision of a physician 7
or physician assistant. 8
2. As used in this section, “accredited college of medicine” has 9
the meaning ascribed to it in NRS 453.375. 10
Sec. 18. NRS 689A.0437 is hereby amended to read as 11
follows: 12
689A.0437 1. An insurer that offers or issues a policy of 13
health insurance shall include in the policy coverage for: 14
(a) All drugs approved by the United States Food and Drug 15
Administration for preventing the acquisition of human 16
immunodeficiency virus or treating human immunodeficiency virus 17
or hepatitis C in the form recommended by the prescribing 18
practitioner, regardless of whether the drug is included in the 19
formulary of the insurer; 20
(b) Laboratory testing that is necessary for therapy that uses a 21
drug to prevent the acquisition of human immunodeficiency virus; 22
(c) Any service to test for, prevent or treat human 23
immunodeficiency virus or hepatitis C provided by a provider of 24
primary care if the service is covered when provided by a specialist 25
and: 26
(1) The service is within the scope of practice of the provider 27
of primary care; or 28
(2) The provider of primary care is capable of providing the 29
service safely and effectively in consultation with a specialist and 30
the provider engages in such consultation; and 31
(d) [The] Ordering laboratory testing described in paragraph 32
(b) and the services described in NRS 639.28085, when provided by 33
a pharmacist who participates in the network plan of the insurer. 34
2. An insurer that offers or issues a policy of health insurance 35
shall reimburse: 36
(a) A pharmacist who participates in the network plan of the 37
insurer for the services described in [NRS 639.28085] paragraph 38
(d) of subsection 1 at a rate equal to the rate of reimbursement 39
provided to a physician, physician assistant or advanced practice 40
registered nurse for similar services. 41
(b) An advanced practice registered nurse or a physician 42
assistant who participates in the network plan of the insurer for any 43
service to test for, prevent or treat human immunodeficiency virus 44
– 21 –
- *AB186*
or hepatitis C at a rate equal to the rate of reimbursement provided 1
to a physician for similar services. 2
3. An insurer shall not: 3
(a) Subject the benefits required by subsection 1 to medical 4
management techniques, other than step therapy; 5
(b) Limit the covered amount of a drug described in paragraph 6
(a) of subsection 1; 7
(c) Refuse to cover a drug described in paragraph (a) of 8
subsection 1 because the drug is dispensed by a pharmacy through 9
mail order service; or 10
(d) Prohibit or restrict access to any service or drug to treat 11
human immunodeficiency virus or hepatitis C on the same day on 12
which the insured is diagnosed. 13
4. An insurer shall ensure that the benefits required by 14
subsection 1 are made available to an insured through a provider of 15
health care who participates in the network plan of the insurer. 16
5. A policy of health insurance subject to the provisions of this 17
chapter that is delivered, issued for delivery or renewed on or after 18
January 1, 2024, has the legal effect of including the coverage 19
required by subsection 1, and any provision of the policy that 20
conflicts with the provisions of this section is void. 21
6. As used in this section: 22
(a) “Medical management technique” means a practice which is 23
used to control the cost or use of health care services or prescription 24
drugs. The term includes, without limitation, the use of step therapy, 25
prior authorization and categorizing drugs and devices based on 26
cost, type or method of administration. 27
(b) “Network plan” means a policy of health insurance offered 28
by an insurer under which the financing and delivery of medical 29
care, including items and services paid for as medical care, are 30
provided, in whole or in part, through a defined set of providers 31
under contract with the insurer. The term does not include an 32
arrangement for the financing of premiums. 33
(c) “Primary care” means the practice of family medicine, 34
pediatrics, internal medicine, obstetrics and gynecology and 35
midwifery. 36
(d) “Provider of health care” has the meaning ascribed to it in 37
NRS 629.031. 38
Sec. 19. NRS 689B.0312 is hereby amended to read as 39
follows: 40
689B.0312 1. An insurer that offers or issues a policy of 41
group health insurance shall include in the policy coverage for: 42
(a) All drugs approved by the United States Food and Drug 43
Administration for preventing the acquisition of human 44
immunodeficiency virus or treating human immunodeficiency virus 45
– 22 –
- *AB186*
or hepatitis C in the form recommended by the prescribing 1
practitioner, regardless of whether the drug is included in the 2
formulary of the insurer; 3
(b) Laboratory testing that is necessary for therapy that uses a 4
drug to prevent the acquisition of human immunodeficiency virus; 5
(c) Any service to test for, prevent or treat human 6
immunodeficiency virus or hepatitis C provided by a provider of 7
primary care if the service is covered when provided by a specialist 8
and: 9
(1) The service is within the scope of practice of the provider 10
of primary care; or 11
(2) The provider of primary care is capable of providing the 12
service safely and effectively in consultation with a specialist and 13
the provider engages in such consultation; and 14
(d) [The] Ordering laboratory testing described in paragraph 15
(b) and the services described in NRS 639.28085, when provided by 16
a pharmacist who participates in the network plan of the insurer. 17
2. An insurer that offers or issues a policy of group health 18
insurance shall reimburse: 19
(a) A pharmacist who participates in the network plan of the 20
insurer for the services described in [NRS 639.28085] paragraph 21
(d) of subsection 1 at a rate equal to the rate of reimbursement 22
provided to a physician, physician assistant or advanced practice 23
registered nurse for similar services. 24
(b) An advanced practice registered nurse or a physician 25
assistant who participates in the network plan of the insurer for any 26
service to test for, prevent or treat human immunodeficiency virus 27
or hepatitis C at a rate equal to the rate of reimbursement provided 28
to a physician for similar services. 29
3. An insurer shall not: 30
(a) Subject the benefits required by subsection 1 to medical 31
management techniques, other than step therapy; 32
(b) Limit the covered amount of a drug described in paragraph 33
(a) of subsection 1; 34
(c) Refuse to cover a drug described in paragraph (a) of 35
subsection 1 because the drug is dispensed by a pharmacy through 36
mail order service; or 37
(d) Prohibit or restrict access to any service or drug to treat 38
human immunodeficiency virus or hepatitis C on the same day on 39
which the insured is diagnosed. 40
4. An insurer shall ensure that the benefits required by 41
subsection 1 are made available to an insured through a provider of 42
health care who participates in the network plan of the insurer. 43
5. A policy of group health insurance subject to the provisions 44
of this chapter that is delivered, issued for delivery or renewed on or 45
– 23 –
- *AB186*
after January 1, 2024, has the legal effect of including the coverage 1
required by subsection 1, and any provision of the policy that 2
conflicts with the provisions of this section is void. 3
6. As used in this section: 4
(a) “Medical management technique” means a practice which is 5
used to control the cost or use of health care services or prescription 6
drugs. The term includes, without limitation, the use of step therapy, 7
prior authorization and categorizing drugs and devices based on 8
cost, type or method of administration. 9
(b) “Network plan” means a policy of group health insurance 10
offered by an insurer under which the financing and delivery of 11
medical care, including items and services paid for as medical care, 12
are provided, in whole or in part, through a defined set of providers 13
under contract with the insurer. The term does not include an 14
arrangement for the financing of premiums. 15
(c) “Primary care” means the practice of family medicine, 16
pediatrics, internal medicine, obstetrics and gynecology and 17
midwifery. 18
(d) “Provider of health care” has the meaning ascribed to it in 19
NRS 629.031. 20
Sec. 20. NRS 689C.1671 is hereby amended to read as 21
follows: 22
689C.1671 1. A carrier that offers or issues a health benefit 23
plan shall include in the plan coverage for: 24
(a) All drugs approved by the United States Food and Drug 25
Administration for preventing the acquisition of human 26
immunodeficiency virus or treating human immunodeficiency virus 27
or hepatitis C in the form recommended by the prescribing 28
practitioner, regardless of whether the drug is included in the 29
formulary of the carrier; 30
(b) Laboratory testing that is necessary for therapy that uses a 31
drug to prevent the acquisition of human immunodeficiency virus; 32
(c) Any service to test for, prevent or treat human 33
immunodeficiency virus or hepatitis C provided by a provider of 34
primary care if the service is covered when provided by a specialist 35
and: 36
(1) The service is within the scope of practice of the provider 37
of primary care; or 38
(2) The provider of primary care is capable of providing the 39
service safely and effectively in consultation with a specialist and 40
the provider engages in such consultation; and 41
(d) [The] Ordering laboratory testing described in paragraph 42
(b) and the services described in NRS 639.28085, when provided by 43
a pharmacist who participates in the health benefit plan of the 44
carrier. 45
– 24 –
- *AB186*
2. A carrier that offers or issues a health benefit plan shall 1
reimburse: 2
(a) A pharmacist who participates in the health benefit plan of 3
the carrier for the services described in [NRS 639.28085] paragraph 4
(d) of subsection 1 at a rate equal to the rate of reimbursement 5
provided to a physician, physician assistant or advanced practice 6
registered nurse for similar services. 7
(b) An advanced practice registered nurse or a physician 8
assistant who participates in the network plan of the carrier for any 9
service to test for, prevent or treat human immunodeficiency virus 10
or hepatitis C at a rate equal to the rate of reimbursement provided 11
to a physician for similar services. 12
3. A carrier shall not: 13
(a) Subject the benefits required by subsection 1 to medical 14
management techniques, other than step therapy; 15
(b) Limit the covered amount of a drug described in paragraph 16
(a) of subsection 1; 17
(c) Refuse to cover a drug described in paragraph (a) of 18
subsection 1 because the drug is dispensed by a pharmacy through 19
mail order service; or 20
(d) Prohibit or restrict access to any service or drug to treat 21
human immunodeficiency virus or hepatitis C on the same day on 22
which the insured is diagnosed. 23
4. A carrier shall ensure that the benefits required by 24
subsection 1 are made available to an insured through a provider of 25
health care who participates in the network plan of the carrier. 26
5. A health benefit plan subject to the provisions of this chapter 27
that is delivered, issued for delivery or renewed on or after 28
January 1, 2024, has the legal effect of including the coverage 29
required by subsection 1, and any provision of the plan that conflicts 30
with the provisions of this section is void. 31
6. As used in this section: 32
(a) “Medical management technique” means a practice which is 33
used to control the cost or use of health care services or prescription 34
drugs. The term includes, without limitation, the use of step therapy, 35
prior authorization and categorizing drugs and devices based on 36
cost, type or method of administration. 37
(b) “Network plan” means a health benefit plan offered by a 38
carrier under which the financing and delivery of medical care, 39
including items and services paid for as medical care, are provided, 40
in whole or in part, through a defined set of providers under contract 41
with the carrier. The term does not include an arrangement for the 42
financing of premiums. 43
– 25 –
- *AB186*
(c) “Primary care” means the practice of family medicine, 1
pediatrics, internal medicine, obstetrics and gynecology and 2
midwifery. 3
(d) “Provider of health care” has the meaning ascribed to it in 4
NRS 629.031. 5
Sec. 21. NRS 695A.1843 is hereby amended to read as 6
follows: 7
695A.1843 1. A society that offers or issues a benefit 8
contract shall include in the benefit coverage for: 9
(a) All drugs approved by the United States Food and Drug 10
Administration for preventing the acquisition of human 11
immunodeficiency virus or treating human immunodeficiency virus 12
or hepatitis C in the form recommended by the prescribing 13
practitioner, regardless of whether the drug is included in the 14
formulary of the society; 15
(b) Laboratory testing that is necessary for therapy that uses a 16
drug to prevent the acquisition of human immunodeficiency virus; 17
(c) Any service to test for, prevent or treat human 18
immunodeficiency virus or hepatitis C provided by a provider of 19
primary care if the service is covered when provided by a specialist 20
and: 21
(1) The service is within the scope of practice of the provider 22
of primary care; or 23
(2) The provider of primary care is capable of providing the 24
service safely and effectively in consultation with a specialist and 25
the provider engages in such consultation; and 26
(d) [The] Ordering laboratory testing described in paragraph 27
(b) and the services described in NRS 639.28085, when provided by 28
a pharmacist who participates in the network plan of the society. 29
2. A society that offers or issues a benefit contract shall 30
reimburse: 31
(a) A pharmacist who participates in the network plan of the 32
society for the services described in [NRS 639.28085] paragraph 33
(d) of subsection 1 at a rate equal to the rate of reimbursement 34
provided to a physician, physician assistant or advanced practice 35
registered nurse for similar services. 36
(b) An advanced practice registered nurse or a physician 37
assistant who participates in the network plan of the society for any 38
service to test for, prevent or treat human immunodeficiency virus 39
or hepatitis C at a rate equal to the rate of reimbursement provided 40
to a physician for similar services. 41
3. A society shall not: 42
(a) Subject the benefits required by subsection 1 to medical 43
management techniques, other than step therapy; 44
– 26 –
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(b) Limit the covered amount of a drug described in paragraph 1
(a) of subsection 1; 2
(c) Refuse to cover a drug described in paragraph (a) of 3
subsection 1 because the drug is dispensed by a pharmacy through 4
mail order service; or 5
(d) Prohibit or restrict access to any service or drug to treat 6
human immunodeficiency virus or hepatitis C on the same day on 7
which the insured is diagnosed. 8
4. A society shall ensure that the benefits required by 9
subsection 1 are made available to an insured through a provider of 10
health care who participates in the network plan of the society. 11
5. A benefit contract subject to the provisions of this chapter 12
that is delivered, issued for delivery or renewed on or after 13
January 1, 2024, has the legal effect of including the coverage 14
required by subsection 1, and any provision of the plan that conflicts 15
with the provisions of this section is void. 16
6. As used in this section: 17
(a) “Medical management technique” means a practice which is 18
used to control the cost or use of health care services or prescription 19
drugs. The term includes, without limitation, the use of step therapy, 20
prior authorization and categorizing drugs and devices based on 21
cost, type or method of administration. 22
(b) “Network plan” means a benefit contract offered by a society 23
under which the financing and delivery of medical care, including 24
items and services paid for as medical care, are provided, in whole 25
or in part, through a defined set of providers under contract with the 26
society. The term does not include an arrangement for the financing 27
of premiums. 28
(c) “Primary care” means the practice of family medicine, 29
pediatrics, internal medicine, obstetrics and gynecology and 30
midwifery. 31
(d) “Provider of health care” has the meaning ascribed to it in 32
NRS 629.031. 33
Sec. 22. NRS 695B.1924 is hereby amended to read as 34
follows: 35
695B.1924 1. A hospital or medical services corporation that 36
offers or issues a policy of health insurance shall include in the 37
policy coverage for: 38
(a) All drugs approved by the United States Food and Drug 39
Administration for preventing the acquisition of human 40
immunodeficiency virus or treating human immunodeficiency virus 41
or hepatitis C in the form recommended by the prescribing 42
practitioner, regardless of whether the drug is included in the 43
formulary of the hospital or medical services organization; 44
– 27 –
- *AB186*
(b) Laboratory testing that is necessary for therapy using a drug 1
to prevent the acquisition of human immunodeficiency virus; 2
(c) Any service to test for, prevent or treat human 3
immunodeficiency virus or hepatitis C provided by a provider of 4
primary care if the service is covered when provided by a specialist 5
and: 6
(1) The service is within the scope of practice of the provider 7
of primary care; or 8
(2) The provider of primary care is capable of providing the 9
service safely and effectively in consultation with a specialist and 10
the provider engages in such consultation; and 11
(d) [The] Ordering laboratory testing described in paragraph 12
(b) and the services described in NRS 639.28085, when provided by 13
a pharmacist who participates in the network plan of the hospital or 14
medical services corporation. 15
2. A hospital or medical services corporation that offers or 16
issues a policy of health insurance shall reimburse: 17
(a) A pharmacist who participates in the network plan of the 18
hospital or medical services corporation for the services described in 19
[NRS 639.28085] paragraph (d) of subsection 1 at a rate equal to 20
the rate of reimbursement provided to a physician, physician 21
assistant or advanced practice registered nurse for similar services. 22
(b) An advanced practice registered nurse or a physician 23
assistant who participates in the network plan of the hospital or 24
medical services corporation for any service to test for, prevent or 25
treat human immunodeficiency virus or hepatitis C at a rate equal to 26
the rate of reimbursement provided to a physician for similar 27
services. 28
3. A hospital or medical services corporation shall not: 29
(a) Subject the benefits required by subsection 1 to medical 30
management techniques, other than step therapy; 31
(b) Limit the covered amount of a drug described in paragraph 32
(a) of subsection 1; 33
(c) Refuse to cover a drug described in paragraph (a) of 34
subsection 1 because the drug is dispensed by a pharmacy through 35
mail order service; or 36
(d) Prohibit or restrict access to any service or drug to treat 37
human immunodeficiency virus or hepatitis C on the same day on 38
which the insured is diagnosed. 39
4. A hospital or medical services corporation shall ensure that 40
the benefits required by subsection 1 are made available to an 41
insured through a provider of health care who participates in the 42
network plan of the hospital or medical services corporation. 43
5. A policy of health insurance subject to the provisions of this 44
chapter that is delivered, issued for delivery or renewed on or after 45
– 28 –
- *AB186*
January 1, 2024, has the legal effect of including the coverage 1
required by subsection 1, and any provision of the policy that 2
conflicts with the provisions of this section is void. 3
6. As used in this section: 4
(a) “Medical management technique” means a practice which is 5
used to control the cost or use of health care services or prescription 6
drugs. The term includes, without limitation, the use of step therapy, 7
prior authorization and categorizing drugs and devices based on 8
cost, type or method of administration. 9
(b) “Network plan” means a policy of health insurance offered 10
by a hospital or medical services corporation under which the 11
financing and delivery of medical care, including items and services 12
paid for as medical care, are provided, in whole or in part, through a 13
defined set of providers under contract with the hospital or medical 14
services corporation. The term does not include an arrangement for 15
the financing of premiums. 16
(c) “Primary care” means the practice of family medicine, 17
pediatrics, internal medicine, obstetrics and gynecology and 18
midwifery. 19
(d) “Provider of health care” has the meaning ascribed to it in 20
NRS 629.031. 21
Sec. 23. NRS 695C.1743 is hereby amended to read as 22
follows: 23
695C.1743 1. A health maintenance organization that offers 24
or issues a health care plan shall include in the plan coverage for: 25
(a) All drugs approved by the United States Food and Drug 26
Administration for preventing the acquisition of human 27
immunodeficiency virus or treating human immunodeficiency virus 28
or hepatitis C in the form recommended by the prescribing 29
practitioner, regardless of whether the drug is included in the 30
formulary of the health maintenance organization; 31
(b) Laboratory testing that is necessary for therapy that uses a 32
drug to prevent the acquisition of human immunodeficiency virus; 33
(c) Any service to test for, prevent or treat human 34
immunodeficiency virus or hepatitis C provided by a provider of 35
primary care if the service is covered when provided by a specialist 36
and: 37
(1) The service is within the scope of practice of the provider 38
of primary care; or 39
(2) The provider of primary care is capable of providing the 40
service safely and effectively in consultation with a specialist and 41
the provider engages in such consultation; and 42
(d) [The] Ordering laboratory testing described in paragraph 43
(b) and the services described in NRS 639.28085, when provided by 44
– 29 –
- *AB186*
a pharmacist who participates in the network plan of the health 1
maintenance organization. 2
2. A health maintenance organization that offers or issues a 3
health care plan shall reimburse: 4
(a) A pharmacist who participates in the network plan of the 5
health maintenance organization for the services described in [NRS 6
639.28085] paragraph (d) of subsection 1 at a rate equal to the rate 7
of reimbursement provided to a physician, physician assistant or 8
advanced practice registered nurse for similar services. 9
(b) An advanced practice registered nurse or a physician 10
assistant who participates in the network plan of the health 11
maintenance organization for any service to test for, prevent or treat 12
human immunodeficiency virus or hepatitis C at a rate equal to the 13
rate of reimbursement provided to a physician for similar services. 14
3. A health maintenance organization shall not: 15
(a) Subject the benefits required by subsection 1 to medical 16
management techniques, other than step therapy; 17
(b) Limit the covered amount of a drug described in paragraph 18
(a) of subsection 1; 19
(c) Refuse to cover a drug described in paragraph (a) of 20
subsection 1 because the drug is dispensed by a pharmacy through 21
mail order service; or 22
(d) Prohibit or restrict access to any service or drug to treat 23
human immunodeficiency virus or hepatitis C on the same day on 24
which the enrollee is diagnosed. 25
4. A health maintenance organization shall ensure that the 26
benefits required by subsection 1 are made available to an enrollee 27
through a provider of health care who participates in the network 28
plan of the health maintenance organization. 29
5. A health care plan subject to the provisions of this chapter 30
that is delivered, issued for delivery or renewed on or after 31
January 1, 2024, has the legal effect of including the coverage 32
required by subsection 1, and any provision of the plan that conflicts 33
with the provisions of this section is void. 34
6. As used in this section: 35
(a) “Medical management technique” means a practice which is 36
used to control the cost or use of health care services or prescription 37
drugs. The term includes, without limitation, the use of step therapy, 38
prior authorization and categorizing drugs and devices based on 39
cost, type or method of administration. 40
(b) “Network plan” means a health care plan offered by a health 41
maintenance organization under which the financing and delivery of 42
medical care, including items and services paid for as medical care, 43
are provided, in whole or in part, through a defined set of providers 44
– 30 –
- *AB186*
under contract with the health maintenance organization. The term 1
does not include an arrangement for the financing of premiums. 2
(c) “Primary care” means the practice of family medicine, 3
pediatrics, internal medicine, obstetrics and gynecology and 4
midwifery. 5
(d) “Provider of health care” has the meaning ascribed to it in 6
NRS 629.031. 7
Sec. 24. NRS 695G.1705 is hereby amended to read as 8
follows: 9
695G.1705 1. A managed care organization that offers or 10
issues a health care plan shall include in the plan coverage for: 11
(a) All drugs approved by the United States Food and Drug 12
Administration for preventing the acquisition of human 13
immunodeficiency virus or treating human immunodeficiency virus 14
or hepatitis C in the form recommended by the prescribing 15
practitioner, regardless of whether the drug is included in the 16
formulary of the managed care organization; 17
(b) Laboratory testing that is necessary for therapy that uses a 18
drug to prevent the acquisition of human immunodeficiency virus; 19
(c) Any service to test for, prevent or treat human 20
immunodeficiency virus or hepatitis C provided by a provider of 21
primary care if the service is covered when provided by a specialist 22
and: 23
(1) The service is within the scope of practice of the provider 24
of primary care; or 25
(2) The provider of primary care is capable of providing the 26
service safely and effectively in consultation with a specialist and 27
the provider engages in such consultation; and 28
(d) [The] Ordering laboratory testing described in paragraph 29
(b) and the services described in NRS 639.28085, when provided by 30
a pharmacist who participates in the network plan of the managed 31
care organization. 32
2. A managed care organization that offers or issues a health 33
care plan shall reimburse: 34
(a) A pharmacist who participates in the network plan of the 35
managed care organization for the services described in [NRS 36
639.28085] paragraph (d) of subsection 1 at a rate equal to the rate 37
of reimbursement provided to a physician, physician assistant or 38
advanced practice registered nurse for similar services. 39
(b) An advanced practice registered nurse or a physician 40
assistant who participates in the network plan of the managed care 41
organization for any service to test for, prevent or treat human 42
immunodeficiency virus or hepatitis C at a rate equal to the rate of 43
reimbursement provided to a physician for similar services. 44
3. A managed care organization shall not: 45
– 31 –
- *AB186*
(a) Subject the benefits required by subsection 1 to medical 1
management techniques, other than step therapy; 2
(b) Limit the covered amount of a drug described in paragraph 3
(a) of subsection 1; 4
(c) Refuse to cover a drug described in paragraph (a) of 5
subsection 1 because the drug is dispensed by a pharmacy through 6
mail order service; or 7
(d) Prohibit or restrict access to any service or drug to treat 8
human immunodeficiency virus or hepatitis C on the same day on 9
which the insured is diagnosed. 10
4. A managed care organization shall ensure that the benefits 11
required by subsection 1 are made available to an insured through a 12
provider of health care who participates in the network plan of the 13
managed care organization. 14
5. A health care plan subject to the provisions of this chapter 15
that is delivered, issued for delivery or renewed on or after 16
January 1, 2024, has the legal effect of including the coverage 17
required by subsection 1, and any provision of the plan that conflicts 18
with the provisions of this section is void. 19
6. As used in this section: 20
(a) “Medical management technique” means a practice which is 21
used to control the cost or use of health care services or prescription 22
drugs. The term includes, without limitation, the use of step therapy, 23
prior authorization and categorizing drugs and devices based on 24
cost, type or method of administration. 25
(b) “Network plan” means a health care plan offered by a 26
managed care organization under which the financing and delivery 27
of medical care, including items and services paid for as medical 28
care, are provided, in whole or in part, through a defined set of 29
providers under contract with the managed care organization. The 30
term does not include an arrangement for the financing of 31
premiums. 32
(c) “Primary care” means the practice of family medicine, 33
pediatrics, internal medicine, obstetrics and gynecology and 34
midwifery. 35
(d) “Provider of health care” has the meaning ascribed to it in 36
NRS 629.031. 37
Sec. 25. 1. This section becomes effective upon passage and 38
approval. 39
2. Sections 1 to 24, inclusive, of this act become effective: 40
(a) Upon passage and approval for the purpose of adopting any 41
regulations and performing any other preparatory administrative 42
tasks that are necessary to carry out the provisions of this act; and 43
– 32 –
- *AB186*
(b) On January 1, 2026, for all other purposes. 1
H