S.B. 316
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SENATE BILL NO. 316–SENATORS NGUYEN, STONE, TITUS;
CRUZ-CRAWFORD, DALY, OHRENSCHALL AND SCHEIBLE
MARCH 11, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions relating to insurance.
(BDR 57-777)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§ 39)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to insurance; requiring health insurers, pharmacy
benefit managers and the Commissioner of Insurance to
prepare certain reports; expanding the scope of certain
provisions relating to pharmacy benefit managers;
prohibiting pharmacy benefit managers from engaging in
certain practices; requiring pharmacy benefit managers to
make certain disclosures; requiring pharmacy benefit
managers to pass rebates along to certain insurers and
insureds; requiring certain insurers to use passed-along
rebate funds for certain purposes; prohibiting insurers
from assessing certain cost-sharing obligations in certain
circumstances; providing civil and criminal penalties; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires a pharmacy benefit manager, which is an entity that 1
manages a pharmacy benefits plan, to obtain a certificate of registration as an 2
insurance administrator from the Commissioner of Insurance and comply with the 3
requirements that apply to insurance administrators generally. (NRS 683A.025, 4
683A.08522-683A.0893) Existing law additionally imposes certain requirements 5
specifically regulating the operation of pharmacy benefit managers. (NRS 6
683A.171-683A.179) Existing law defines “pharmacy benefits plan” to refer to 7
insurance coverage of prescription drugs. (NRS 683A.175) Section 21 of this bill 8
expands the scope of that definition to also refer to insurance coverage of 9
pharmacist services. Section 21 thereby expands the scope of provisions governing 10
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pharmacy benefit managers to also apply to entities that manage such coverage. 11
Sections 3-14 of this bill define certain other terms relevant to pharmacy benefit 12
managers, and section 20 of this bill establishes the applicability of those 13
definitions. Section 15 of this bill prohibits a pharmacy benefit manager that 14
manages a pharmacy benefits plan which provides coverage through a network 15
from requiring a person to use a pharmacy affiliated with the pharmacy benefit 16
manager if there are other, nonaffiliated pharmacies in the network. Section 15 17
additionally prohibits a pharmacy benefit manager from engaging in certain 18
practices which are intended or have the effect of steering a person towards an 19
affiliated pharmacy instead of a nonaffiliated pharmacy in the network. Section 15 20
also prohibits a pharmacy benefit manager from discriminating against a 21
nonaffiliated pharmacy. 22
Section 16 of this bill requires a pharmacy benefit manager to disclose to a 23
third party insurer for which the pharmacy benefit manager manages a pharmacy 24
benefits plan: (1) the amounts and types of fees that the pharmacy benefit manager 25
charges the third party insurer for managing the plan or otherwise receives from 26
other entities, including rebates, in connection with managing the plan; and (2) 27
certain information relating to the clinical efficacy and evidence regarding the 28
inclusion or exclusion of certain drugs in a formulary. Section 16 additionally 29
requires a pharmacy benefit manager to make certain contracts available for 30
inspection by the Commissioner. 31
Existing law authorizes the Department of Health and Human Services to enter 32
into a contract with a pharmacy benefit manager to manage coverage of 33
prescription drugs under the State Plan for Medicaid and the Children’s Health 34
Insurance Program that requires the pharmacy benefit manager to provide to the 35
Department all rebates received for purchasing drugs in relation to those programs. 36
(NRS 422.4053) Section 16 imposes similar requirements for pharmacy benefit 37
managers that manage other pharmacy benefits plans. Specifically, section 16 38
requires a pharmacy benefit manager to provide the entire amount of any rebate the 39
pharmacy benefit manager receives in connection with providing pharmacy benefit 40
management services for a third party insurer that provides pharmacy coverage to 41
the third party insurer. Sections 25, 27-32, 35, 36, 40 and 41 of this bill require 42
certain third party insurers that provide coverage for prescription drugs to use any 43
rebate money received from a pharmacy benefit manager pursuant to section 16 for 44
the sole purpose of reducing premiums and eliminating or reducing cost-sharing 45
obligations of covered persons. Sections 25, 27-32, 35, 36, 40 and 41 also prohibit 46
third party insurers from imposing on an insured a cost-sharing obligation for a 47
prescription drug which is greater than the net amount that the third party insurer 48
pays for the drug. Section 26 of this bill authorizes the Commissioner to require a 49
domestic insurer that issues a policy of individual health insurance to a person 50
residing in another state to meet the requirements of section 25 in certain 51
circumstances. Sections 33 and 37 of this bill indicate that the requirements of 52
sections 32 and 36, respectively, are inapplicable to a managed care organization 53
that is providing coverage to recipients of Medicaid because existing law imposes 54
similar requirements of the Medicaid program. (NRS 422.4053) Section 34 of this 55
bill authorizes the Commissioner to suspend or revoke the certificate of a health 56
maintenance organization that fails to comply with the requirements of section 32. 57
The Commissioner would also be authorized to take such action against other third 58
party insurers who fail to comply with the requirements of sections 25, 27-32, 35 59
and 36. (NRS 680A.200) 60
Section 17 of this bill prohibits a pharmacy benefit manager from: (1) 61
unreasonably obstructing or interfering with the ability of a covered person to 62
timely access a prescription drug at certain pharmacies; (2) agreeing to exclusively 63
cover certain drugs; (3) restricting the ability of a nonaffiliated pharmacy to 64
contract with certain entities; and (4) making or disseminating a false or misleading 65
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statement or advertisement. Section 24 of this bill additionally prohibits a 66
pharmacy benefit manager from engaging in certain practices while doing business 67
with pharmacies. 68
Section 19 of this bill requires a pharmacy benefit manager to submit to the 69
Commissioner an annual report detailing certain business practices of the pharmacy 70
benefit manager as well as certain information regarding pricing and rebates 71
relating to the prescription drugs administered by the pharmacy benefit manager. 72
Section 1 of this bill requires third party insurers to submit a similar report to the 73
Commissioner relating to the pricing of prescription drugs. Section 39 of this bill 74
provides for the confidentiality of the information contained in those reports. 75
Sections 1 and 19 require the Commissioner to compile, submit to the Legislature 76
and publish on the Internet biennial reports on the impact of the cost of prescription 77
drugs on health insurance premiums in this State and the overall impact of 78
pharmacy benefit managers on the cost of prescription drugs in this State, based on 79
the reports submitted by third party insurers and pharmacy benefit managers, 80
respectively. Additionally, section 18 of this bill requires the Commissioner to 81
publish on the Internet certain consumer complaints made against pharmacy benefit 82
managers. 83
Existing law exempts certain federally regulated insurance coverage of 84
prescription drugs provided by employers for their employees from requirements 85
governing pharmacy benefit managers except where the pharmacy benefit manager 86
is required by contract to comply with those requirements. (NRS 683A.177) 87
Section 22 of this bill provides that such federally regulated coverage provided by 88
employers for their employees is also exempt from the requirements of this bill 89
governing pharmacy benefit managers, unless required by contract to comply with 90
those requirements. 91
Existing law provides that a pharmacy benefit manager has an obligation of 92
good faith and fair dealing toward a third party insurer or pharmacy when 93
performing duties pursuant to a contract to which the pharmacy benefit manager is 94
a party. (NRS 683A.178) Section 23 of this bill provides that a pharmacy benefit 95
manager also has an obligation to act with care, skill, prudence, diligence and 96
professionalism towards persons covered by a third party insurer when providing 97
pharmacy benefit services pursuant to a contract with the third party insurer. 98
Section 18 provides that a pharmacy benefit manager that violates provisions of 99
law governing pharmacy benefit managers, including sections 3-24, is subject to a 100
civil penalty of not less than $1,000 but not more than $7,500 for each violation. 101
Existing law defines various activities involving businesses and occupations 102
that constitute deceptive trade practices. (NRS 598.0915-589.0925) If a person 103
engages in a deceptive trade practice, the person may be subject to a civil action 104
brought by certain persons and certain civil and criminal penalties. (NRS 598.0999) 105
Section 18 makes certain violations of sections 15 and 24 a deceptive trade 106
practice, thereby subjecting a violation of those provisions to additional penalties. 107
However, sections 18, 38 and 42 of this bill provide that such violations do not 108
give rise to a private right of action. 109
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THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 679B of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. On or before April 1 of each year, a health insurer shall 3
compile and submit to the Commissioner a report which contains 4
the following information: 5
(a) Lists of: 6
(1) The 25 prescription drugs most frequently prescribed to 7
insureds in this State during the immediately preceding calendar 8
year; 9
(2) The 25 prescription drugs which accounted for the 10
largest percentage of spending on prescription drugs in this State 11
by the health insurer in the immediately preceding year; and 12
(3) The 25 prescription drugs with the largest increase in 13
the percentage of spending on prescription drugs in this State by 14
the health insurer in the immediately preceding year, as compared 15
to the previous year; and 16
(b) For each prescription drug included on a list compiled 17
pursuant to paragraph (a) for the immediately preceding year: 18
(1) The aggregate wholesale acquisition costs for the drug, 19
calculated by adding together for all units of the drug dispensed to 20
insureds in this State the wholesale acquisition cost of the drug at 21
the time each unit was dispensed; 22
(2) The aggregate amount of rebates received by a 23
pharmacy benefit manager under contract with the insurer 24
relating to the distribution of the drug to insureds in this State; 25
(3) The aggregate amount of administrative fees received 26
by a pharmacy benefit manager under contract with the insurer 27
relating to the distribution of the drug to insureds in this State; 28
(4) The aggregate amount paid or reimbursed by a 29
pharmacy benefit manager under contract with the insurer to 30
affiliated pharmacies in this State for the drug; 31
(5) The aggregate amount paid or reimbursed by a 32
pharmacy benefit manager under contract with an insurer to 33
nonaffiliated pharmacies in this State for the drug; and 34
(6) The aggregate amount of fees received from any source 35
by a pharmacy benefit manager under contract with the insurer 36
relating to the distribution of the drug to insureds in this State. 37
2. On or before July 1 of each even-numbered year, the 38
Commissioner shall: 39
(a) Compile a report on the overall impact of prescription drug 40
costs on premiums for health insurance in this State based on the 41
reports submitted to the Commissioner pursuant to subsection 1. 42
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The data in the report compiled pursuant to this subsection must 1
be in aggregated form and must not reveal information specific to 2
a particular health insurer or manufacturer of a drug, including, 3
without limitation, information relating to a manufacturer’s 4
individual or aggregate discounted prices for a prescription drug. 5
(b) Submit the report to the Director of the Legislative Counsel 6
Bureau for transmittal to the Joint Interim Standing Committee 7
on Health and Human Services and the Joint Interim Standing 8
Committee on Commerce and Labor. 9
(c) Present the report at a meeting of the Joint Interim 10
Standing Committee on Health and Human Services. 11
(d) Post the report on an Internet website operated by the 12
Division. 13
3. Except as otherwise provided in subsection 2, any 14
information submitted by a health insurer pursuant to this section 15
is confidential and is not a public record. 16
4. As used in this section: 17
(a) “Affiliated pharmacy” has the meaning ascribed to it in 18
section 3 of this act. 19
(b) “Health insurer” means any insurer or organization 20
authorized pursuant to this title to conduct business in this State 21
that provides or arranges for the provision of health care services, 22
including, without limitation, an insurer that issues a policy of 23
health insurance, an insurer that issues a policy of group health 24
insurance, a carrier serving small employers, a fraternal benefit 25
society, a hospital or medical services corporation, a health 26
maintenance organization, a plan for dental care, a prepaid 27
limited health service organization and a managed care 28
organization. 29
(c) “Insured” means a person covered by a policy of health 30
insurance issued in this State by a health insurer. 31
(d) “Manufacturer” has the meaning ascribed to it in 42 32
U.S.C. § 1396r-8(k)(5). 33
(e) “National Drug Code” means the numerical code assigned 34
to a prescription drug by the United States Food and Drug 35
Administration. 36
(f) “Nonaffiliated pharmacy” has the meaning ascribed to it in 37
section 9 of this act. 38
(g) “Pharmacy benefit manager” has the meaning ascribed to 39
it in NRS 683A.174. 40
(h) “Rebate” has the meaning ascribed to it in section 13 of 41
this act. 42
(i) “Wholesale acquisition cost” means the manufacturer’s 43
published list price for a prescription drug with a unique National 44
Drug Code for sale to a purchaser or entity that purchases the 45
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prescription drug from the manufacturer, not including any 1
rebates or other price concessions. 2
Sec. 2. Chapter 683A of NRS is hereby amended by adding 3
thereto the provisions set forth as sections 3 to 19, inclusive, of this 4
act. 5
Sec. 3. “Affiliated pharmacy” means a pharmacy that 6
directly, or indirectly through one or more intermediaries, 7
controls, is controlled by or is under common control with a 8
pharmacy benefit manager. 9
Sec. 4. “Claim” means a request for payment for: 10
1. Administering, filling or refilling a prescription; or 11
2. Providing a pharmacist service or a medical supply or 12
device to a covered person. 13
Sec. 5. “Control” has the meaning ascribed to it in 14
NRS 692C.050. 15
Sec. 6. “Cost-sharing obligation” includes, without 16
limitation, a copayment, coinsurance or deductible imposed upon 17
or collected from a covered person in connection with filling a 18
prescription or obtaining other pharmacist services. 19
Sec. 7. “Manufacturer” has the meaning ascribed to it in 42 20
U.S.C. § 1396r-8(k)(5). 21
Sec. 8. “Network plan” means a pharmacy benefits plan 22
offered by a third party under which the financing and delivery of 23
pharmacist services is provided, in whole or in part, through a 24
defined set of providers under contract with the third party. The 25
term does not include an arrangement for the financing of 26
premiums. 27
Sec. 9. “Nonaffiliated pharmacy” means a pharmacy that: 28
1. Directly, or indirectly through a pharmacy services 29
administrative organization, contracts with a pharmacy benefit 30
manager; and 31
2. Does not control, is not controlled by and is not under 32
common control with the pharmacy benefit manager. 33
Sec. 10. “Pharmacist services” means the provision of 34
products, goods or services, or any combination thereof, provided 35
as a part of the practice of pharmacy, as defined in NRS 639.0124. 36
Sec. 11. “Pharmacy benefit management services” includes, 37
without limitation: 38
1. Negotiating the price of prescription drugs, including, 39
without limitation, negotiating or contracting for direct or indirect 40
rebates, discounts or price concessions on prescription drugs. 41
2. Managing any aspect of a pharmacy benefits plan, 42
including, without limitation: 43
(a) Developing or managing a formulary; 44
(b) Processing and paying claims for prescription drugs; 45
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(c) Performing reviews of the utilization of prescription drugs; 1
(d) Processing requests for prior authorization for 2
prescriptions; 3
(e) Adjudicating appeals and grievances relating to a 4
pharmacy benefits plan; 5
(f) Contracting with pharmacies to provide pharmacist services 6
for covered persons; 7
(g) Managing the cost of covered prescription drugs on behalf 8
of a third party; and 9
(h) Managing or providing data relating to a pharmacy 10
benefits plan. 11
3. Performing any administrative, managerial, clinical, 12
pricing, financial, reimbursement, data administration, reporting 13
or billing service for a third party in relation to a pharmacy 14
benefits plan. 15
Sec. 12. “Pharmacy services administrative organization” 16
means an entity that provides contracting and other administrative 17
services relating to prescription drug benefits to pharmacies. 18
Sec. 13. “Rebate” means any discount, remuneration or 19
other payment paid by a manufacturer or wholesaler to a 20
pharmacy benefit manager after a claim has been adjudicated or 21
completed at a pharmacy. The term does not include a bona fide 22
service fee, as defined in 42 C.F.R. § 447.502. 23
Sec. 14. “Wholesaler” has the meaning ascribed to it in 24
NRS 639.016. 25
Sec. 15. 1. A pharmacy benefit manager that manages a 26
network plan shall not: 27
(a) Require a covered person to use an affiliated pharmacy to 28
fill a prescription or obtain other pharmacist services if there is a 29
nonaffiliated pharmacy in the applicable network; 30
(b) Except as authorized by subsection 2, induce, persuade or 31
attempt to induce or persuade a covered person to transfer a 32
prescription to or otherwise use an affiliated pharmacy instead of 33
a nonaffiliated pharmacy in the applicable network; 34
(c) Unreasonably restrict a covered person from using a 35
particular pharmacy in the applicable network for the purpose of 36
filling a prescription or receiving pharmacist services covered by 37
the pharmacy benefits plan of the covered person; 38
(d) Communicate to a covered person that the covered person 39
is required to have a prescription filled or receive other pharmacist 40
services at a particular pharmacy if there are other pharmacies in 41
the applicable network that have the ability to dispense the 42
prescription or provide the pharmacist services required by the 43
covered person; 44
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(e) Discriminate against a nonaffiliated pharmacy based on 1
the nonaffiliated status of the pharmacy, including, without 2
limitation, by: 3
(1) Offering materially different terms or conditions to a 4
nonaffiliated pharmacy based on the status as a nonaffiliated 5
pharmacy; 6
(2) Refusing to renew or terminating a contract with a 7
nonaffiliated pharmacy on the basis that the pharmacy is a 8
nonaffiliated pharmacy, or for reasons other than those that apply 9
equally to affiliated pharmacies; and 10
(3) Reimbursing a nonaffiliated pharmacy for a pharmacist 11
service in an amount that is less than the pharmacy benefit 12
manager would reimburse an affiliated pharmacy for the same 13
pharmacist service; or 14
(f) Deny a pharmacy the opportunity to participate in a 15
network or receive a preferred status if the pharmacy is willing to 16
accept the same terms and conditions that the pharmacy benefit 17
manager has established for affiliated pharmacies as a condition 18
for participating in the network or receiving preferred status, as 19
applicable. 20
2. A third party or pharmacy benefit manager may reduce the 21
amount of an applicable cost-sharing obligation of a covered 22
person who fills a prescription or obtains other pharmacist 23
services at a particular pharmacy. The third party or pharmacy 24
benefit manager must reduce the cost-sharing obligation to an 25
amount that is less than the cost-sharing obligation that the 26
covered person would otherwise pay to fill the same prescription or 27
obtain the same pharmacist services at any other pharmacy in the 28
network under the terms of the applicable pharmacy benefits plan. 29
3. As used in this section, “network” means a defined set of 30
pharmacies that are under contract to provide pharmacist services 31
pursuant to a network plan. 32
Sec. 16. A pharmacy benefit manager: 33
1. Upon the request of a third party for which the pharmacy 34
benefit manager manages a pharmacy benefits plan, shall disclose 35
to the third party, in writing, the amounts and types of charges, 36
fees and commissions that the pharmacy benefit manager charges 37
the third party for providing pharmacy benefit management 38
services or otherwise receives in connection with managing the 39
pharmacy benefits plan of the third party, including, without 40
limitation, administrative fees and rebates collected from 41
manufacturers and wholesalers. 42
2. Except as otherwise provided in NRS 422.4053, shall 43
transmit the entire amount of any rebate received from a 44
manufacturer or wholesaler in connection with providing 45
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pharmacy benefit management services for a third party to the 1
third party to which the rebate pertains. 2
3. Shall make available for inspection by the Commissioner, 3
upon request of the Commissioner, any contract between the 4
pharmacy benefit manager and a pharmacy or a third party. 5
4. Shall disclose to a third party for which the pharmacy 6
benefit manager manages a pharmacy benefits plan, upon request 7
of the third party, information relating to the clinical efficacy and 8
clinical evidence regarding the inclusion, exclusion or limitation 9
of prescription drugs in a formulary maintained by the pharmacy 10
benefit manager. 11
Sec. 17. 1. A pharmacy benefit manager shall not: 12
(a) Unreasonably obstruct or interfere with the ability of a 13
covered person to timely access a prescription drug or device that 14
has been prescribed to the covered person at a contract pharmacy 15
of the person’s choice. 16
(b) Enter into, amend, enforce or renew a contract with a 17
manufacturer that expressly or implicitly provides for the 18
exclusive coverage of a drug, medical device or other product by a 19
pharmacy benefits plan or group of pharmacy benefits plans. 20
(c) Enter into, amend, enforce or renew a contract with a 21
pharmacy or pharmacy services administrative organization that 22
expressly or implicitly restricts the ability of a nonaffiliated 23
pharmacy to contract with third parties. 24
(d) Make or disseminate any statement, representation or 25
advertisement that is, or reasonably should be known to be, 26
untrue, deceptive or misleading. 27
2. As used in this section, “contract pharmacy” means a 28
pharmacy that contracts directly with a pharmacy benefit 29
manager, or indirectly with a pharmacy benefit manager through 30
a pharmacy services administrative organization. 31
Sec. 18. 1. A pharmacy benefit manager that violates the 32
provisions of NRS 683A.171 to 683A.179, inclusive, and sections 3 33
to 19, inclusive, of this act is subject to a civil penalty of not less 34
than $1,000, but not more than $7,500, for each violation. This 35
penalty must be recovered in a civil action brought in the name of 36
the State of Nevada by the Attorney General. 37
2. Except as otherwise provided in this subsection, a violation 38
of paragraph (l) of subsection 1 of NRS 683A.179 or section 15 of 39
this act constitutes a deceptive trade practice for the purposes of 40
NRS 598.0903 to 598.0999, inclusive. This subsection does not 41
create a private right of action. 42
3. The Attorney General may: 43
(a) Conduct an investigation to determine whether a pharmacy 44
benefit manager, either directly or indirectly, has violated, is 45
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violating or is about to violate the provisions of NRS 683A.171 to 1
683A.179, inclusive, and sections 3 to 19, inclusive, of this act, or 2
any regulations adopted thereto. 3
(b) If he or she believes that a pharmacy benefit manager, 4
either directly or indirectly, is violating or is about to violate the 5
provisions of NRS 683A.171 to 683A.179, inclusive, and sections 3 6
to 19, inclusive, of this act, seek an injunction or other equitable 7
relief to halt or prevent such a violation. 8
4. The remedies and penalties set forth in this section are not 9
exclusive and are in addition to any other remedies and penalties 10
provided by law. 11
5. The Commissioner shall: 12
(a) Establish procedures for receiving, investigating, tracking 13
and publicly reporting complaints submitted by persons in this 14
State against pharmacy benefit managers. 15
(b) Publish on an Internet website maintained by the 16
Commissioner each complaint against a pharmacy benefit 17
manager received pursuant to paragraph (a) which is determined 18
by the Commissioner to be justified based on a determination by a 19
preponderance of the evidence that the pharmacy benefit manager 20
violated the provisions of NRS 683A.171 to 683A.179, inclusive, 21
and sections 3 to 19, inclusive, of this act. 22
Sec. 19. 1. On or before April 1 of each year, a pharmacy 23
benefit manager shall submit to the Commissioner: 24
(a) A report which includes the information prescribed by 25
subsection 2; and 26
(b) A statement signed under the penalty of perjury affirming 27
the accuracy of the information in the report. 28
2. The report submitted pursuant to paragraph (a) of 29
subsection 1 must include: 30
(a) Lists of: 31
(1) The 50 prescription drugs with the highest wholesale 32
acquisition costs at the time the report is submitted; 33
(2) The 50 prescription drugs most frequently prescribed to 34
covered persons in this State during the immediately preceding 35
calendar year; and 36
(3) The 50 prescription drugs which produced the largest 37
amount of revenue for the pharmacy benefit manager in this State 38
during the immediately preceding calendar year. 39
(b) For each prescription for a drug included on a list 40
compiled pursuant to paragraph (a) that was issued to a covered 41
person in this State during the immediately preceding year: 42
(1) The type of pharmacy that filled the prescription. The 43
type of pharmacy may be an integrated pharmacy, chain 44
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pharmacy, specialty pharmacy, mail order pharmacy or other type 1
of pharmacy. 2
(2) Information relating to pricing of and rebates for the 3
drug, including, without limitation: 4
(I) The total amount that the pharmacy benefit manager 5
paid to the pharmacy for filling the prescription; 6
(II) The net amount that the pharmacy benefit manager 7
paid to the pharmacy for filling the prescription, after accounting 8
for any fees or assessments imposed by the pharmacy benefit 9
manager against the pharmacy; 10
(III) The amount of any rebate negotiated by the 11
pharmacy benefit manager with the manufacturer for the 12
purchase of the drug; 13
(IV) The amount of any rebate described in sub-14
subparagraph (III) that was passed on to either the applicable 15
third party or the covered person; and 16
(V) The amount that the applicable third party paid the 17
pharmacy benefit manager for the drug. 18
(c) Information prescribed by regulation of the Commissioner 19
that allows the Commissioner to determine whether each claim for 20
a prescription drug included on a list compiled pursuant to 21
paragraph (a) required prior authorization. Such information 22
must be in deidentified form. 23
(d) For each prescription drug appearing on a list compiled 24
pursuant to paragraph (a), the aggregate amount for the 25
immediately preceding year of the: 26
(1) Cost of the drug, calculated by adding together for all 27
units of the drug dispensed in this State the wholesale acquisition 28
cost of the drug at the time each unit was dispensed; 29
(2) Amount of rebates negotiated for the purchase of the 30
drug in this State; 31
(3) Amount of administrative fees received from a 32
manufacturer or wholesaler for services provided in this State 33
relating to the drug; 34
(4) Amount paid or reimbursed to affiliated pharmacies in 35
this State for the drug; and 36
(5) Amount paid or reimbursed to nonaffiliated pharmacies 37
in this State for the drug. 38
(e) A list of the third parties with which the pharmacy benefit 39
manager has contracted, the scope of services provided to each 40
third party and the number of persons covered in this State by 41
each third party listed. 42
(f) The total amount of revenue derived from providing 43
pharmacy benefit management services in this State in the 44
immediately preceding year. 45
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(g) The expenses incurred by providing pharmacy benefit 1
management services in this State in the immediately preceding 2
year. 3
(h) The identity of each group purchasing organization 4
employed, contracted or otherwise utilized by or affiliated with the 5
pharmacy benefit manager. 6
(i) A copy of each contract entered into with a group 7
purchasing organization identified pursuant to paragraph (h). 8
(j) The aggregate financial benefit derived in the immediately 9
preceding year from the use of the group purchasing 10
organizations identified pursuant to paragraph (h). 11
(k) A list of the types and amounts of fees that the pharmacy 12
benefit manager has collected during the immediately preceding 13
year for performing pharmacy benefit management services in this 14
State and a description of how those fees are calculated. 15
(l) A copy of all fee agreements entered into with third parties, 16
pharmacies and pharmacy services administrative organizations 17
doing business in this State. 18
(m) The amount of each premium, deductible, cost-sharing 19
obligation or fee charged by the pharmacy benefit manager to 20
covered persons in this State or other persons on behalf of such 21
covered persons. 22
3. On or before July 1 of each even-numbered year, the 23
Commissioner shall: 24
(a) Compile a report on the overall impact of pharmacy benefit 25
managers on the cost of prescription drugs in this State based on 26
the reports submitted to the Commissioner pursuant to subsection 27
1. The data in the report compiled pursuant to this subsection 28
must be in aggregated form and must not reveal information 29
specifically concerning an individual purchaser or manufacturer 30
of a drug, including, without limitation, information relating to a 31
manufacturer’s individual or aggregate discounted prices for a 32
prescription drug. 33
(b) Submit the report to the Director of the Legislative Counsel 34
Bureau for transmittal to the Joint Interim Standing Committee 35
on Health and Human Services and the Joint Interim Standing 36
Committee on Commerce and Labor. 37
(c) Present the report at a meeting of the Joint Interim 38
Standing Committee on Health and Human Services. 39
(d) Post the report on an Internet website operated by the 40
Division. 41
4. Except as otherwise provided in subsection 3, any 42
information submitted by a pharmacy benefit manager pursuant to 43
this section is confidential and is not a public record. 44
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5. Nothing in this section shall be construed to impose any 1
recordkeeping obligation on a third party for which a pharmacy 2
benefit manager manages a pharmacy benefits plan. 3
6. As used in this section: 4
(a) “Group purchasing organization” means a person 5
employed, contracted or otherwise utilized by or affiliated with a 6
pharmacy benefit manager to negotiate, obtain or procure rebates 7
from manufacturers or wholesalers. 8
(b) “National Drug Code” means the numerical code assigned 9
to a prescription drug by the United States Food and Drug 10
Administration. 11
(c) “Wholesale acquisition cost” means the manufacturer’s 12
published list price for a prescription drug with a unique National 13
Drug Code for sale to a wholesaler or any other purchaser or 14
entity that purchases the prescription drug from the manufacturer, 15
not including any rebates or other price concessions. 16
Sec. 20. NRS 683A.171 is hereby amended to read as follows: 17
683A.171 As used in NRS 683A.171 to 683A.179, inclusive, 18
and sections 3 to 19, inclusive, of this act, unless the context 19
otherwise requires, the words and terms defined in NRS 683A.172 20
to 683A.176, inclusive, and sections 3 to 14, inclusive, of this act 21
have the meanings ascribed to them in those sections. 22
Sec. 21. NRS 683A.175 is hereby amended to read as follows: 23
683A.175 “Pharmacy benefits plan” means coverage of 24
prescription drugs and pharmacist services provided by a third 25
party. 26
Sec. 22. NRS 683A.177 is hereby amended to read as follows: 27
683A.177 1. Except as otherwise provided in subsection 2, 28
the requirements of NRS 683A.171 to 683A.179, inclusive, and 29
sections 3 to 19, inclusive, of this act and any regulations adopted 30
by the Commissioner pursuant thereto do not apply to the coverage 31
of prescription drugs under a plan that is subject to the Employee 32
Retirement Income Security Act of 1974 or any information relating 33
to such coverage. 34
2. A plan described in subsection 1 may, by contract, require a 35
pharmacy benefit manager that manages the coverage of 36
prescription drugs under the plan to comply with the requirements 37
of NRS 683A.171 to 683A.179, inclusive, and sections 3 to 19, 38
inclusive, of this act and any regulations adopted by the 39
Commissioner pursuant thereto. 40
Sec. 23. NRS 683A.178 is hereby amended to read as follows: 41
683A.178 1. A pharmacy benefit manager has an obligation 42
[of] : 43
(a) Of good faith and fair dealing toward a third party or 44
pharmacy when performing duties pursuant to a contract to which 45
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the pharmacy benefit manager is a party. Any provision of a 1
contract that waives or limits that obligation is against public policy, 2
void and unenforceable. 3
(b) To act with care, skill, prudence, diligence and 4
professionalism towards persons covered by a third party when 5
providing pharmacy benefit management services when 6
performing duties pursuant to a contract between the pharmacy 7
benefit manager and the third party. 8
2. A pharmacy benefit manager shall notify a third party with 9
which it has entered into a contract in writing of any activity, policy 10
or practice of the pharmacy benefit manager that presents a conflict 11
of interest that interferes with the obligations imposed by 12
subsection 1. 13
3. A pharmacy benefit manager that manages prescription drug 14
benefits for an insurer licensed pursuant to this title shall comply 15
with the provisions of this title which are applicable to the insurer 16
when managing such benefits for the insurer. 17
Sec. 24. NRS 683A.179 is hereby amended to read as follows: 18
683A.179 1. A pharmacy benefit manager shall not: 19
(a) Prohibit a pharmacist or pharmacy from providing 20
information to a covered person concerning: 21
(1) The amount of any copayment or coinsurance for a 22
prescription drug; or 23
(2) The availability of a less expensive alternative or generic 24
drug including, without limitation, information concerning clinical 25
efficacy of such a drug; 26
(b) Penalize a pharmacist or pharmacy for providing the 27
information described in paragraph (a) or selling a less expensive 28
alternative or generic drug to a covered person; 29
(c) Prohibit a pharmacy from offering or providing delivery 30
services directly to a covered person as an ancillary service of the 31
pharmacy; [or] 32
(d) If the pharmacy benefit manager manages a pharmacy 33
benefits plan that provides coverage through a network plan, charge 34
a copayment or coinsurance for a prescription drug in an amount 35
that is greater than the total amount paid to a pharmacy that is in the 36
network of providers under contract with the third party [.] ; 37
(e) Restrict, by contract or otherwise, the ability of a pharmacy 38
to share or disclose the details of a contract between the pharmacy 39
and the pharmacy benefit manager with the Commissioner; 40
(f) Reimburse a pharmacy for a prescription drug in an 41
amount that is less than the pharmacy pays a wholesaler for the 42
prescription drug, as reflected on the invoice provided by the 43
wholesaler to the pharmacy; 44
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(g) Directly or indirectly reduce or allow the reduction of any 1
payment to a pharmacy under a pharmacy benefits plan managed 2
by the pharmacy benefit manager under a reconciliation process 3
to an effective rate of reimbursement; 4
(h) Directly or indirectly retroactively reduce or deny a claim 5
after the claim has been adjudicated unless: 6
(1) The original claim is fraudulent; 7
(2) The original payment of the claim was incorrect 8
because the pharmacy or pharmacist had already been paid for the 9
pharmacist services to which the claim relates; or 10
(3) The pharmacy or pharmacist that submitted the claim 11
did not properly render the pharmacist services to which the claim 12
relates; 13
(i) Reverse and resubmit the claim of a pharmacy: 14
(1) Without notifying and attempting to reconcile the claim 15
with the pharmacy; or 16
(2) More than 90 days after the claim was first affirmatively 17
adjudicated; 18
(j) Charge a pharmacy or a pharmacist a fee to process a claim 19
electronically; 20
(k) Refuse to pay a claim after terminating a contract with a 21
pharmacy, except where the pharmacy benefit manager is 22
investigating possible insurance fraud; or 23
(l) Retaliate against a pharmacy for reporting a potential or 24
actual violation of this title or attempting to settle a dispute with a 25
pharmacy benefit manager based on a potential or actual violation 26
of this title. 27
2. The provisions of this section: 28
(a) Must not be construed to authorize a pharmacist to dispense 29
a drug that has not been prescribed by a practitioner, as defined in 30
NRS 639.0125, except to the extent authorized by a specific 31
provision of law, including, without limitation, NRS 453C.120, 32
639.28078 and 639.28085. 33
(b) Do not apply to an institutional pharmacy, as defined in NRS 34
639.0085, or a pharmacist working in such a pharmacy as an 35
employee or independent contractor. 36
3. Any provision of a contract that restricts the ability of a 37
pharmacy to share information pursuant to paragraph (e) of 38
subsection 1 is against public policy, void and unenforceable. 39
4. As used in this section, [“network plan” means a health 40
benefit plan offered by a health carrier under which the financing 41
and delivery of medical care is provided, in whole or in part, 42
through a defined set of providers under contract with the carrier. 43
The term does not include an arrangement for the financing of 44
premiums.] “retaliate” includes, without limitation: 45
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(a) Terminating or refusing to renew a contract with a 1
pharmacy. 2
(b) Making the renewal of a contract with a pharmacy 3
contingent on the pharmacy acceding to terms and conditions not 4
applicable to other pharmacies. 5
(c) Subjecting the pharmacy to increased audits. 6
(d) Failing to promptly pay or reimburse a pharmacy without 7
substantial justification. 8
Sec. 25. Chapter 689A of NRS is hereby amended by adding 9
thereto a new section to read as follows: 10
1. An insurer that offers or issues a policy of health 11
insurance which provides coverage for prescription drugs shall 12
not impose a cost-sharing obligation against an insured for a 13
prescription drug that exceeds the net amount that the insurer 14
pays for the drug, inclusive of any rebate received from a 15
pharmacy benefit manager in connection with providing coverage 16
for the drug. 17
2. An insurer that uses a pharmacy benefit manager to 18
manage coverage of prescription drugs included in a policy of 19
health insurance shall use any money received from the pharmacy 20
benefit manager pursuant to section 16 of this act for the sole 21
purpose of reducing premiums and offsetting or reducing cost-22
sharing obligations of insureds. 23
3. As used in this section: 24
(a) “Cost-sharing obligation” has the meaning ascribed to it in 25
section 6 of this act. 26
(b) “Pharmacy benefit manager” has the meaning ascribed to 27
it in NRS 683A.174. 28
Sec. 26. NRS 689A.330 is hereby amended to read as follows: 29
689A.330 If any policy is issued by a domestic insurer for 30
delivery to a person residing in another state, and if the insurance 31
commissioner or corresponding public officer of that other state has 32
informed the Commissioner that the policy is not subject to approval 33
or disapproval by that officer, the Commissioner may by ruling 34
require that the policy meet the standards set forth in NRS 689A.030 35
to 689A.320, inclusive [.] , and section 25 of this act. 36
Sec. 27. Chapter 689B of NRS is hereby amended by adding 37
thereto a new section to read as follows: 38
1. An insurer that offers or issues a policy of group health 39
insurance which provides coverage for prescription drugs shall 40
not impose a cost-sharing obligation against an insured for a 41
prescription drug that exceeds the net amount that the insurer 42
pays for the drug, inclusive of any rebate received from a 43
pharmacy benefit manager in connection with providing coverage 44
for the drug. 45
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2. An insurer that uses a pharmacy benefit manager to 1
manage coverage of prescription drugs included in a policy of 2
group health insurance shall use any money received from the 3
pharmacy benefit manager pursuant to section 16 of this act for 4
the sole purpose of reducing premiums and offsetting or reducing 5
cost-sharing obligations of insureds. 6
3. As used in this section: 7
(a) “Cost-sharing obligation” has the meaning ascribed to it in 8
section 6 of this act. 9
(b) “Pharmacy benefit manager” has the meaning ascribed to 10
it in NRS 683A.174. 11
Sec. 28. Chapter 689C of NRS is hereby amended by adding 12
thereto a new section to read as follows: 13
1. A carrier that offers or issues a health benefit plan which 14
provides coverage for prescription drugs shall not impose a cost-15
sharing obligation against an insured for a prescription drug that 16
exceeds the net amount that the carrier pays for the drug, 17
inclusive of any rebate received from a pharmacy benefit manager 18
in connection with providing coverage for the drug. 19
2. A carrier that uses a pharmacy benefit manager to manage 20
coverage of prescription drugs included in a health benefit plan 21
shall use any money received from the pharmacy benefit manager 22
pursuant to section 16 of this act for the sole purpose of reducing 23
premiums and offsetting or reducing cost-sharing obligations of 24
insureds. 25
3. As used in this section: 26
(a) “Cost-sharing obligation” has the meaning ascribed to it in 27
section 6 of this act. 28
(b) “Pharmacy benefit manager” has the meaning ascribed to 29
it in NRS 683A.174. 30
Sec. 29. NRS 689C.425 is hereby amended to read as follows: 31
689C.425 A voluntary purchasing group and any contract 32
issued to such a group pursuant to NRS 689C.360 to 689C.600, 33
inclusive, are subject to the provisions of NRS 689C.015 to 34
689C.355, inclusive, and section 28 of this act, to the extent 35
applicable and not in conflict with the express provisions of NRS 36
687B.408 and 689C.360 to 689C.600, inclusive. 37
Sec. 30. Chapter 695A of NRS is hereby amended by adding 38
thereto a new section to read as follows: 39
1. A society that offers or issues a benefit contract which 40
provides coverage for prescription drugs shall not impose a cost-41
sharing obligation against an insured for a prescription drug that 42
exceeds the net amount that the society pays for the drug, inclusive 43
of any rebate received from a pharmacy benefit manager in 44
connection with providing coverage for the drug. 45
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2. A society that uses a pharmacy benefit manager to manage 1
coverage of prescription drugs included in a benefit contract shall 2
use any money received from the pharmacy benefit manager 3
pursuant to section 16 of this act for the sole purpose of reducing 4
premiums and offsetting or reducing cost-sharing obligations of 5
insureds. 6
3. As used in this section: 7
(a) “Cost-sharing obligation” has the meaning ascribed to it in 8
section 6 of this act. 9
(b) “Pharmacy benefit manager” has the meaning ascribed to 10
it in NRS 683A.174. 11
Sec. 31. Chapter 695B of NRS is hereby amended by adding 12
thereto a new section to read as follows: 13
1. A hospital or medical services corporation that offers or 14
issues a policy of health insurance which provides coverage for 15
prescription drugs shall not impose a cost-sharing obligation 16
against an insured for a prescription drug that exceeds the net 17
amount that the hospital or medical services corporation pays for 18
the drug, inclusive of any rebate received from a pharmacy benefit 19
manager in connection with providing coverage for the drug. 20
2. A hospital or medical services corporation that uses a 21
pharmacy benefit manager to manage coverage of prescription 22
drugs included in a policy of health insurance shall use any 23
money received from the pharmacy benefit manager pursuant to 24
section 16 of this act for the sole purpose of reducing premiums 25
and offsetting or reducing cost-sharing obligations of insureds. 26
3. As used in this section: 27
(a) “Cost-sharing obligation” has the meaning ascribed to it in 28
section 6 of this act. 29
(b) “Pharmacy benefit manager” has the meaning ascribed to 30
it in NRS 683A.174. 31
Sec. 32. Chapter 695C of NRS is hereby amended by adding 32
thereto a new section to read as follows: 33
1. A health maintenance organization that offers or issues a 34
health care plan which provides coverage for prescription drugs 35
shall not impose a cost-sharing obligation against an enrollee for 36
a prescription drug that exceeds the net amount that the health 37
maintenance organization pays for the drug, inclusive of any 38
rebate received from a pharmacy benefit manager in connection 39
with providing coverage for the drug. 40
2. A health maintenance organization that uses a pharmacy 41
benefit manager to manage coverage of prescription drugs 42
included in a health care plan shall use any money received from 43
the pharmacy benefit manager pursuant to section 16 of this act 44
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for the sole purpose of reducing premiums and offsetting or 1
reducing cost-sharing obligations of enrollees. 2
3. As used in this section: 3
(a) “Cost-sharing obligation” has the meaning ascribed to it in 4
section 6 of this act. 5
(b) “Pharmacy benefit manager” has the meaning ascribed to 6
it in NRS 683A.174. 7
Sec. 33. NRS 695C.050 is hereby amended to read as follows: 8
695C.050 1. Except as otherwise provided in this chapter or 9
in specific provisions of this title, the provisions of this title are not 10
applicable to any health maintenance organization granted a 11
certificate of authority under this chapter. This provision does not 12
apply to an insurer licensed and regulated pursuant to this title 13
except with respect to its activities as a health maintenance 14
organization authorized and regulated pursuant to this chapter. 15
2. Solicitation of enrollees by a health maintenance 16
organization granted a certificate of authority, or its representatives, 17
must not be construed to violate any provision of law relating to 18
solicitation or advertising by practitioners of a healing art. 19
3. Any health maintenance organization authorized under this 20
chapter shall not be deemed to be practicing medicine and is exempt 21
from the provisions of chapter 630 of NRS. 22
4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 23
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 24
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 25
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 26
inclusive, and 695C.265 and section 32 of this act do not apply to a 27
health maintenance organization that provides health care services 28
through managed care to recipients of Medicaid under the State Plan 29
for Medicaid or insurance pursuant to the Children’s Health 30
Insurance Program pursuant to a contract with the Division of 31
Health Care Financing and Policy of the Department of Health and 32
Human Services. This subsection does not exempt a health 33
maintenance organization from any provision of this chapter for 34
services provided pursuant to any other contract. 35
5. The provisions of NRS 695C.16932 to 695C.1699, 36
inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 37
695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, 38
inclusive, 695C.1757 and 695C.204 apply to a health maintenance 39
organization that provides health care services through managed 40
care to recipients of Medicaid under the State Plan for Medicaid. 41
6. The provisions of NRS 695C.17095 do not apply to a health 42
maintenance organization that provides health care services to 43
members of the Public Employees’ Benefits Program. This 44
subsection does not exempt a health maintenance organization from 45
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any provision of this chapter for services provided pursuant to any 1
other contract. 2
7. The provisions of NRS 695C.1735 do not apply to a health 3
maintenance organization that provides health care services to: 4
(a) The officers and employees, and the dependents of officers 5
and employees, of the governing body of any county, school district, 6
municipal corporation, political subdivision, public corporation or 7
other local governmental agency of this State; or 8
(b) Members of the Public Employees’ Benefits Program. 9
This subsection does not exempt a health maintenance 10
organization from any provision of this chapter for services 11
provided pursuant to any other contract. 12
Sec. 34. NRS 695C.330 is hereby amended to read as follows: 13
695C.330 1. The Commissioner may suspend or revoke any 14
certificate of authority issued to a health maintenance organization 15
pursuant to the provisions of this chapter if the Commissioner finds 16
that any of the following conditions exist: 17
(a) The health maintenance organization is operating 18
significantly in contravention of its basic organizational document, 19
its health care plan or in a manner contrary to that described in and 20
reasonably inferred from any other information submitted pursuant 21
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 22
to those submissions have been filed with and approved by the 23
Commissioner; 24
(b) The health maintenance organization issues evidence of 25
coverage or uses a schedule of charges for health care services 26
which do not comply with the requirements of NRS 695C.1691 to 27
695C.200, inclusive, and section 32 of this act or 695C.204 or 28
695C.207; 29
(c) The health care plan does not furnish comprehensive health 30
care services as provided for in NRS 695C.060; 31
(d) The Commissioner certifies that the health maintenance 32
organization: 33
(1) Does not meet the requirements of subsection 1 of NRS 34
695C.080; or 35
(2) Is unable to fulfill its obligations to furnish health care 36
services as required under its health care plan; 37
(e) The health maintenance organization is no longer financially 38
responsible and may reasonably be expected to be unable to meet its 39
obligations to enrollees or prospective enrollees; 40
(f) The health maintenance organization has failed to put into 41
effect a mechanism affording the enrollees an opportunity to 42
participate in matters relating to the content of programs pursuant to 43
NRS 695C.110; 44
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(g) The health maintenance organization has failed to put into 1
effect the system required by NRS 695C.260 for: 2
(1) Resolving complaints in a manner reasonably to dispose 3
of valid complaints; and 4
(2) Conducting external reviews of adverse determinations 5
that comply with the provisions of NRS 695G.241 to 695G.310, 6
inclusive; 7
(h) The health maintenance organization or any person on its 8
behalf has advertised or merchandised its services in an untrue, 9
misrepresentative, misleading, deceptive or unfair manner; 10
(i) The continued operation of the health maintenance 11
organization would be hazardous to its enrollees or creditors or to 12
the general public; 13
(j) The health maintenance organization fails to provide the 14
coverage required by NRS 695C.1691; or 15
(k) The health maintenance organization has otherwise failed to 16
comply substantially with the provisions of this chapter. 17
2. A certificate of authority must be suspended or revoked only 18
after compliance with the requirements of NRS 695C.340. 19
3. If the certificate of authority of a health maintenance 20
organization is suspended, the health maintenance organization shall 21
not, during the period of that suspension, enroll any additional 22
groups or new individual contracts, unless those groups or persons 23
were contracted for before the date of suspension. 24
4. If the certificate of authority of a health maintenance 25
organization is revoked, the organization shall proceed, immediately 26
following the effective date of the order of revocation, to wind up its 27
affairs and shall conduct no further business except as may be 28
essential to the orderly conclusion of the affairs of the organization. 29
It shall engage in no further advertising or solicitation of any kind. 30
The Commissioner may, by written order, permit such further 31
operation of the organization as the Commissioner may find to be in 32
the best interest of enrollees to the end that enrollees are afforded 33
the greatest practical opportunity to obtain continuing coverage for 34
health care. 35
Sec. 35. Chapter 695F of NRS is hereby amended by adding 36
thereto a new section to read as follows: 37
1. A prepaid limited health service organization that provides 38
coverage for prescription drugs shall not impose a cost-sharing 39
obligation against an enrollee for a prescription drug that exceeds 40
the net amount that the prepaid limited health service organization 41
pays for the drug, inclusive of any rebate received from a 42
pharmacy benefit manager in connection with providing coverage 43
for the drug. 44
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2. A prepaid limited health service organization that uses a 1
pharmacy benefit manager to manage coverage of prescription 2
drugs included in evidence of coverage shall use any money 3
received from the pharmacy benefit manager pursuant to section 4
16 of this act for the sole purpose of reducing premiums and 5
offsetting or reducing cost-sharing obligations of enrollees. 6
3. As used in this section: 7
(a) “Cost-sharing obligation” has the meaning ascribed to it in 8
section 6 of this act. 9
(b) “Pharmacy benefit manager” has the meaning ascribed to 10
it in NRS 683A.174. 11
Sec. 36. Chapter 695G of NRS is hereby amended by adding 12
thereto a new section to read as follows: 13
1. A managed care organization that offers or issues a health 14
care plan which provides coverage for prescription drugs shall not 15
impose a cost-sharing obligation against an insured for a 16
prescription drug that exceeds the net amount that the managed 17
care organization pays for the drug, inclusive of any rebate 18
received from a pharmacy benefit manager in connection with 19
providing coverage for the drug. 20
2. A managed care organization that uses a pharmacy benefit 21
manager to manage coverage of prescription drugs included in a 22
health care plan shall use any money received from the pharmacy 23
benefit manager pursuant to section 16 of this act for the sole 24
purpose of reducing premiums and offsetting or reducing cost-25
sharing obligations of insureds. 26
3. As used in this section: 27
(a) “Cost-sharing obligation” has the meaning ascribed to it in 28
section 6 of this act. 29
(b) “Pharmacy benefit manager” has the meaning ascribed to 30
it in NRS 683A.174. 31
Sec. 37. NRS 695G.090 is hereby amended to read as follows: 32
695G.090 1. Except as otherwise provided in subsection 3, 33
the provisions of this chapter apply to each organization and insurer 34
that operates as a managed care organization and may include, 35
without limitation, an insurer that issues a policy of health 36
insurance, an insurer that issues a policy of individual or group 37
health insurance, a carrier serving small employers, a fraternal 38
benefit society, a hospital or medical service corporation and a 39
health maintenance organization. 40
2. In addition to the provisions of this chapter, each managed 41
care organization shall comply with: 42
(a) The provisions of chapter 686A of NRS, including all 43
obligations and remedies set forth therein; and 44
(b) Any other applicable provision of this title. 45
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3. The provisions of NRS 695G.127, 695G.1639, 695G.164, 1
695G.1645, 695G.167 and 695G.200 to 695G.230, inclusive, and 2
section 36 of this act do not apply to a managed care organization 3
that provides health care services to recipients of Medicaid under 4
the State Plan for Medicaid or insurance pursuant to the Children’s 5
Health Insurance Program pursuant to a contract with the Division 6
of Health Care Financing and Policy of the Department of Health 7
and Human Services. 8
4. The provisions of NRS 695C.1735 and 695G.1639 do not 9
apply to a managed care organization that provides health care 10
services to members of the Public Employees’ Benefits Program. 11
5. Subsections 3 and 4 do not exempt a managed care 12
organization from any provision of this chapter for services 13
provided pursuant to any other contract. 14
Sec. 38. NRS 41.600 is hereby amended to read as follows: 15
41.600 1. [An] Except as otherwise provided in section 18, 16
an action may be brought by any person who is a victim of 17
consumer fraud. 18
2. As used in this section, “consumer fraud” means: 19
(a) An unlawful act as defined in NRS 119.330; 20
(b) An unlawful act as defined in NRS 205.2747; 21
(c) An act prohibited by NRS 482.36655 to 482.36667, 22
inclusive; 23
(d) An act prohibited by NRS 482.351; 24
(e) A deceptive trade practice as defined in NRS 598.0915 to 25
598.0925, inclusive; or 26
(f) A violation of NRS 417.133 or 417.135. 27
3. If the claimant is the prevailing party, the court shall award 28
the claimant: 29
(a) Any damages that the claimant has sustained; 30
(b) Any equitable relief that the court deems appropriate; and 31
(c) The claimant’s costs in the action and reasonable attorney’s 32
fees. 33
4. Any action brought pursuant to this section is not an action 34
upon any contract underlying the original transaction. 35
Sec. 39. NRS 239.010 is hereby amended to read as follows: 36
239.010 1. Except as otherwise provided in this section and 37
NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 38
49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 39
62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 40
80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 41
87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 42
88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 43
116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 44
119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 45
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120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 1
127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 2
130.712, 136.050, 159.044, 159A.044, 164.041, 172.075, 172.245, 3
176.01334, 176.01385, 176.015, 176.0625, 176.09129, 176.156, 4
176A.630, 178.39801, 178.4715, 178.5691, 178.5717, 179.495, 5
179A.070, 179A.165, 179D.160, 180.600, 200.3771, 200.3772, 6
200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 7
209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 8
213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 9
218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 218G.615, 10
224.240, 226.462, 226.796, 228.270, 228.450, 228.495, 228.570, 11
231.069, 231.1285, 231.1473, 232.1369, 233.190, 237.300, 12
239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 13
239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 14
239C.420, 240.007, 241.020, 241.030, 241.039, 242.105, 244.264, 15
244.335, 247.540, 247.545, 247.550, 247.560, 250.087, 250.130, 16
250.140, 250.145, 250.150, 268.095, 268.0978, 268.490, 268.910, 17
269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 18
281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 284.4086, 19
286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 20
293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 21
293.906, 293.908, 293.909, 293.910, 293B.135, 293D.510, 331.110, 22
332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 23
338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 24
353A.049, 353A.085, 353A.100, 353C.240, 353D.250, 360.240, 25
360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 26
366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 27
379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 28
387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 29
388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 30
391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 31
392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 32
394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 33
396.159, 396.3295, 396.405, 396.525, 396.535, 396.9685, 34
398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 35
414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 36
425.400, 427A.1236, 427A.872, 427A.940, 432.028, 432.205, 37
432B.175, 432B.280, 432B.290, 432B.4018, 432B.407, 432B.430, 38
432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 39
439.4941, 439.4988, 439.5282, 439.840, 439.914, 439A.116, 40
439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 41
441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 42
442.774, 445A.665, 445B.570, 445B.7773, 449.209, 449.245, 43
449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 44
453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 45
– 25 –
- *SB316*
459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 1
463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 2
481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 3
483.575, 483.659, 483.800, 484A.469, 484B.830, 484B.833, 4
484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 5
571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 6
598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 7
604D.500, 604D.600, 612.265, 616B.012, 616B.015, 616B.315, 8
616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 9
624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 10
628B.760, 629.043, 629.047, 629.069, 630.133, 630.2671, 11
630.2672, 630.2673, 630.2687, 630.30665, 630.336, 630A.327, 12
630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 13
632.3423, 632.405, 633.283, 633.301, 633.427, 633.4715, 633.4716, 14
633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 15
634A.185, 634B.730, 635.111, 635.158, 636.262, 636.342, 637.085, 16
637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 17
639.2485, 639.570, 640.075, 640.152, 640A.185, 640A.220, 18
640B.405, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 19
640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 20
641.221, 641.2215, 641A.191, 641A.217, 641A.262, 641B.170, 21
641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D.320, 22
642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 23
645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 24
645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 25
648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 26
654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 27
669.285, 669A.310, 670B.680, 671.365, 671.415, 673.450, 673.480, 28
675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 29
678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 30
679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 31
681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 32
687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 33
688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 34
692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 35
696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 36
711.600, and sections 1 and 19 of this act, sections 35, 38 and 41 of 37
chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, 38
Statutes of Nevada 2013 and unless otherwise declared by law to be 39
confidential, all public books and public records of a governmental 40
entity must be open at all times during office hours to inspection by 41
any person, and may be fully copied or an abstract or memorandum 42
may be prepared from those public books and public records. Any 43
such copies, abstracts or memoranda may be used to supply the 44
general public with copies, abstracts or memoranda of the records or 45
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may be used in any other way to the advantage of the governmental 1
entity or of the general public. This section does not supersede or in 2
any manner affect the federal laws governing copyrights or enlarge, 3
diminish or affect in any other manner the rights of a person in any 4
written book or record which is copyrighted pursuant to federal law. 5
2. A governmental entity may not reject a book or record 6
which is copyrighted solely because it is copyrighted. 7
3. A governmental entity that has legal custody or control of a 8
public book or record shall not deny a request made pursuant to 9
subsection 1 to inspect or copy or receive a copy of a public book or 10
record on the basis that the requested public book or record contains 11
information that is confidential if the governmental entity can 12
redact, delete, conceal or separate, including, without limitation, 13
electronically, the confidential information from the information 14
included in the public book or record that is not otherwise 15
confidential. 16
4. If requested, a governmental entity shall provide a copy of a 17
public record in an electronic format by means of an electronic 18
medium. Nothing in this subsection requires a governmental entity 19
to provide a copy of a public record in an electronic format or by 20
means of an electronic medium if: 21
(a) The public record: 22
(1) Was not created or prepared in an electronic format; and 23
(2) Is not available in an electronic format; or 24
(b) Providing the public record in an electronic format or by 25
means of an electronic medium would: 26
(1) Give access to proprietary software; or 27
(2) Require the production of information that is confidential 28
and that cannot be redacted, deleted, concealed or separated from 29
information that is not otherwise confidential. 30
5. An officer, employee or agent of a governmental entity who 31
has legal custody or control of a public record: 32
(a) Shall not refuse to provide a copy of that public record in the 33
medium that is requested because the officer, employee or agent has 34
already prepared or would prefer to provide the copy in a different 35
medium. 36
(b) Except as otherwise provided in NRS 239.030, shall, upon 37
request, prepare the copy of the public record and shall not require 38
the person who has requested the copy to prepare the copy himself 39
or herself. 40
Sec. 40. NRS 287.010 is hereby amended to read as follows: 41
287.010 1. The governing body of any county, school 42
district, municipal corporation, political subdivision, public 43
corporation or other local governmental agency of the State of 44
Nevada may: 45
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(a) Adopt and carry into effect a system of group life, accident 1
or health insurance, or any combination thereof, for the benefit of its 2
officers and employees, and the dependents of officers and 3
employees who elect to accept the insurance and who, where 4
necessary, have authorized the governing body to make deductions 5
from their compensation for the payment of premiums on the 6
insurance. 7
(b) Purchase group policies of life, accident or health insurance, 8
or any combination thereof, for the benefit of such officers and 9
employees, and the dependents of such officers and employees, as 10
have authorized the purchase, from insurance companies authorized 11
to transact the business of such insurance in the State of Nevada, 12
and, where necessary, deduct from the compensation of officers and 13
employees the premiums upon insurance and pay the deductions 14
upon the premiums. 15
(c) Provide group life, accident or health coverage through a 16
self-insurance reserve fund and, where necessary, deduct 17
contributions to the maintenance of the fund from the compensation 18
of officers and employees and pay the deductions into the fund. The 19
money accumulated for this purpose through deductions from the 20
compensation of officers and employees and contributions of the 21
governing body must be maintained as an internal service fund as 22
defined by NRS 354.543. The money must be deposited in a state or 23
national bank or credit union authorized to transact business in the 24
State of Nevada. Any independent administrator of a fund created 25
under this section is subject to the licensing requirements of chapter 26
683A of NRS, and must be a resident of this State. Any contract 27
with an independent administrator must be approved by the 28
Commissioner of Insurance as to the reasonableness of 29
administrative charges in relation to contributions collected and 30
benefits provided. The provisions of NRS 439.581 to 439.597, 31
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 32
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs 33
(b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 34
and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 35
689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 36
and 689B.500 and section 27 of this act apply to coverage provided 37
pursuant to this paragraph, except that the provisions of NRS 38
689B.0378, 689B.03785 and 689B.500 only apply to coverage for 39
active officers and employees of the governing body, or the 40
dependents of such officers and employees. 41
(d) Defray part or all of the cost of maintenance of a self-42
insurance fund or of the premiums upon insurance. The money for 43
contributions must be budgeted for in accordance with the laws 44
governing the county, school district, municipal corporation, 45
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- *SB316*
political subdivision, public corporation or other local governmental 1
agency of the State of Nevada. 2
2. If a school district offers group insurance to its officers and 3
employees pursuant to this section, members of the board of trustees 4
of the school district must not be excluded from participating in the 5
group insurance. If the amount of the deductions from compensation 6
required to pay for the group insurance exceeds the compensation to 7
which a trustee is entitled, the difference must be paid by the trustee. 8
3. In any county in which a legal services organization exists, 9
the governing body of the county, or of any school district, 10
municipal corporation, political subdivision, public corporation or 11
other local governmental agency of the State of Nevada in the 12
county, may enter into a contract with the legal services 13
organization pursuant to which the officers and employees of the 14
legal services organization, and the dependents of those officers and 15
employees, are eligible for any life, accident or health insurance 16
provided pursuant to this section to the officers and employees, and 17
the dependents of the officers and employees, of the county, school 18
district, municipal corporation, political subdivision, public 19
corporation or other local governmental agency. 20
4. If a contract is entered into pursuant to subsection 3, the 21
officers and employees of the legal services organization: 22
(a) Shall be deemed, solely for the purposes of this section, to be 23
officers and employees of the county, school district, municipal 24
corporation, political subdivision, public corporation or other local 25
governmental agency with which the legal services organization has 26
contracted; and 27
(b) Must be required by the contract to pay the premiums or 28
contributions for all insurance which they elect to accept or of which 29
they authorize the purchase. 30
5. A contract that is entered into pursuant to subsection 3: 31
(a) Must be submitted to the Commissioner of Insurance for 32
approval not less than 30 days before the date on which the contract 33
is to become effective. 34
(b) Does not become effective unless approved by the 35
Commissioner. 36
(c) Shall be deemed to be approved if not disapproved by the 37
Commissioner within 30 days after its submission. 38
6. As used in this section, “legal services organization” means 39
an organization that operates a program for legal aid and receives 40
money pursuant to NRS 19.031. 41
Sec. 41. NRS 287.04335 is hereby amended to read as 42
follows: 43
287.04335 If the Board provides health insurance through a 44
plan of self-insurance, it shall comply with the provisions of 45
– 29 –
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NRS 439.581 to 439.597, inclusive, 686A.135, 687B.352, 1
687B.409, 687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 2
689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 3
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 4
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 5
695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, 6
inclusive, 695G.241 to 695G.310, inclusive, 695G.405 and 7
695G.415, and section 36 of this act, in the same manner as an 8
insurer that is licensed pursuant to title 57 of NRS is required to 9
comply with those provisions. 10
Sec. 42. NRS 598.0977 is hereby amended to read as follows: 11
598.0977 Except as otherwise provided in NRS 603A.550 [,] 12
and section 18 of this act, if an elderly person or a person with a 13
disability suffers damage or injury as a result of a deceptive trade 14
practice, he or she or his or her legal representative, if any, may 15
commence a civil action against any person who engaged in the 16
practice to recover the actual damages suffered by the elderly person 17
or person with a disability, punitive damages, if appropriate, and 18
reasonable attorney’s fees. The collection of any restitution awarded 19
pursuant to this section has a priority over the collection of any civil 20
penalty imposed pursuant to NRS 598.0973. 21
Sec. 43. The amendatory provisions of this act do not apply to 22
any contract or other agreement entered into before January 1, 2026, 23
but apply to the renewal of any such contract or other agreement. 24
Sec. 44. The provisions of subsection 1 of NRS 218D.380 do 25
not apply to any provision of this act which adds or revises a 26
requirement to submit a report to the Legislature. 27
Sec. 45. The provisions of NRS 354.599 do not apply to any 28
additional expenses of a local government that are related to the 29
provisions of this act. 30
Sec. 46. 1. This section becomes effective upon passage and 31
approval. 32
2. Sections 1 to 45, inclusive, of this act become effective: 33
(a) Upon passage and approval for the purpose of adopting any 34
regulations and performing any other preparatory administrative 35
tasks that are necessary to carry out the provisions of this act; and 36
(b) On January 1, 2026, for all other purposes. 37
H