S.B. 354
- *SB354*
SENATE BILL NO. 354–SENATORS STONE;
OHRENSCHALL AND SCHEIBLE
MARCH 13, 2025
____________
JOINT SPONSOR: ASSEMBLYMEMBER EDGEWORTH
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions relating to health insurance
coverage of prescription drugs. (BDR 57-1041)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§ 2 & NRS 287.010)
(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; prohibiting certain health plans from
requiring step therapy before providing coverage for
certain prescription drugs for the prevention of human
immunodeficiency virus or the treatment of human
immunodeficiency virus or hepatitis C; and providing
other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires certain public and private health plans, including 1
Medicaid and health plans for state and local government employees, to cover: (1) 2
drugs that prevent the acquisition of human immunodeficiency virus or that treat 3
human immunodeficiency virus or hepatitis C; (2) related laboratory and diagnostic 4
procedures; and (3) certain other services to test for, prevent or treat human 5
immunodeficiency virus or hepatitis C. (NRS 287.010, 287.04335, 422.4025, 6
689A.0437, 689B.0312, 689C.1671, 695A.1843, 695B.1924, 695C.050, 7
695C.1743, 695G.1705) Existing law prohibits such health plans from 8
implementing any medical management techniques on the coverage of such drugs 9
or services, except the use of step therapy. (NRS 287.010, 287.04335, 689A.0437, 10
689B.0312, 689C.1671, 695A.1843, 695B.1924, 695C.050, 695C.1743, 11
695G.1705) This bill removes the exemption for step therapy, thereby prohibiting 12
such public and private health plans from requiring step therapy before providing 13
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coverage for a drug that: (1) prevents the acquisition of human immunodeficiency 14
virus; or (2) treats human immunodeficiency virus or hepatitis C. 15
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 689A.0437 is hereby amended to read as 1
follows: 2
689A.0437 1. An insurer that offers or issues a policy of 3
health insurance shall include in the policy coverage for: 4
(a) All drugs approved by the United States Food and Drug 5
Administration for preventing the acquisition of human 6
immunodeficiency virus or treating human immunodeficiency virus 7
or hepatitis C in the form recommended by the prescribing 8
practitioner, regardless of whether the drug is included in the 9
formulary of the insurer; 10
(b) Laboratory testing that is necessary for therapy that uses a 11
drug to prevent the acquisition of human immunodeficiency virus; 12
(c) Any service to test for, prevent or treat human 13
immunodeficiency virus or hepatitis C provided by a provider of 14
primary care if the service is covered when provided by a specialist 15
and: 16
(1) The service is within the scope of practice of the provider 17
of primary care; or 18
(2) The provider of primary care is capable of providing the 19
service safely and effectively in consultation with a specialist and 20
the provider engages in such consultation; and 21
(d) The services described in NRS 639.28085, when provided 22
by a pharmacist who participates in the network plan of the insurer. 23
2. An insurer that offers or issues a policy of health insurance 24
shall reimburse: 25
(a) A pharmacist who participates in the network plan of the 26
insurer for the services described in NRS 639.28085 at a rate equal 27
to the rate of reimbursement provided to a physician, physician 28
assistant or advanced practice registered nurse for similar services. 29
(b) An advanced practice registered nurse or a physician 30
assistant who participates in the network plan of the insurer for any 31
service to test for, prevent or treat human immunodeficiency virus 32
or hepatitis C at a rate equal to the rate of reimbursement provided 33
to a physician for similar services. 34
3. An insurer shall not: 35
(a) Subject the benefits required by subsection 1 to medical 36
management techniques ; [, other than step therapy;] 37
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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. An insurer 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 insurer. 11
5. A policy of health insurance subject to the provisions of this 12
chapter that is delivered, issued for delivery or renewed on or after 13
January 1, [2024,] 2026, has the legal effect of including the 14
coverage required by subsection 1, and any provision of the policy 15
that conflicts 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 policy of health insurance offered 23
by an insurer under which the financing and delivery of medical 24
care, including items and services paid for as medical care, are 25
provided, in whole or in part, through a defined set of providers 26
under contract with the insurer. The term does not include an 27
arrangement for the financing 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. 2. NRS 689B.0312 is hereby amended to read as follows: 34
689B.0312 1. An insurer that offers or issues a policy of 35
group health insurance shall include in the policy coverage for: 36
(a) All drugs approved by the United States Food and Drug 37
Administration for preventing the acquisition of human 38
immunodeficiency virus or treating human immunodeficiency virus 39
or hepatitis C in the form recommended by the prescribing 40
practitioner, regardless of whether the drug is included in the 41
formulary of the insurer; 42
(b) Laboratory testing that is necessary for therapy that uses a 43
drug to prevent the acquisition of human immunodeficiency virus; 44
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(c) Any service to test for, prevent or treat human 1
immunodeficiency virus or hepatitis C provided by a provider of 2
primary care if the service is covered when provided by a specialist 3
and: 4
(1) The service is within the scope of practice of the provider 5
of primary care; or 6
(2) The provider of primary care is capable of providing the 7
service safely and effectively in consultation with a specialist and 8
the provider engages in such consultation; and 9
(d) The services described in NRS 639.28085, when provided 10
by a pharmacist who participates in the network plan of the insurer. 11
2. An insurer that offers or issues a policy of group health 12
insurance shall reimburse: 13
(a) A pharmacist who participates in the network plan of the 14
insurer for the services described in NRS 639.28085 at a rate equal 15
to the rate of reimbursement provided to a physician, physician 16
assistant or advanced practice registered nurse for similar services. 17
(b) An advanced practice registered nurse or a physician 18
assistant who participates in the network plan of the insurer for any 19
service to test for, prevent or treat human immunodeficiency virus 20
or hepatitis C at a rate equal to the rate of reimbursement provided 21
to a physician for similar services. 22
3. An insurer shall not: 23
(a) Subject the benefits required by subsection 1 to medical 24
management techniques ; [, other than step therapy;] 25
(b) Limit the covered amount of a drug described in paragraph 26
(a) of subsection 1; 27
(c) Refuse to cover a drug described in paragraph (a) of 28
subsection 1 because the drug is dispensed by a pharmacy through 29
mail order service; or 30
(d) Prohibit or restrict access to any service or drug to treat 31
human immunodeficiency virus or hepatitis C on the same day on 32
which the insured is diagnosed. 33
4. An insurer shall ensure that the benefits required by 34
subsection 1 are made available to an insured through a provider of 35
health care who participates in the network plan of the insurer. 36
5. A policy of group health insurance subject to the provisions 37
of this chapter that is delivered, issued for delivery or renewed on or 38
after January 1, [2024,] 2026, has the legal effect of including the 39
coverage required by subsection 1, and any provision of the policy 40
that conflicts with the provisions of this section is void. 41
6. As used in this section: 42
(a) “Medical management technique” means a practice which is 43
used to control the cost or use of health care services or prescription 44
drugs. The term includes, without limitation, the use of step therapy, 45
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prior authorization and categorizing drugs and devices based on 1
cost, type or method of administration. 2
(b) “Network plan” means a policy of group health insurance 3
offered by an insurer under which the financing and delivery of 4
medical care, including items and services paid for as medical care, 5
are provided, in whole or in part, through a defined set of providers 6
under contract with the insurer. The term does not include an 7
arrangement for the financing of premiums. 8
(c) “Primary care” means the practice of family medicine, 9
pediatrics, internal medicine, obstetrics and gynecology and 10
midwifery. 11
(d) “Provider of health care” has the meaning ascribed to it in 12
NRS 629.031. 13
Sec. 3. NRS 689C.1671 is hereby amended to read as follows: 14
689C.1671 1. A carrier that offers or issues a health benefit 15
plan shall include in the plan coverage for: 16
(a) All drugs approved by the United States Food and Drug 17
Administration for preventing the acquisition of human 18
immunodeficiency virus or treating human immunodeficiency virus 19
or hepatitis C in the form recommended by the prescribing 20
practitioner, regardless of whether the drug is included in the 21
formulary of the carrier; 22
(b) Laboratory testing that is necessary for therapy that uses a 23
drug to prevent the acquisition of human immunodeficiency virus; 24
(c) Any service to test for, prevent or treat human 25
immunodeficiency virus or hepatitis C provided by a provider of 26
primary care if the service is covered when provided by a specialist 27
and: 28
(1) The service is within the scope of practice of the provider 29
of primary care; or 30
(2) The provider of primary care is capable of providing the 31
service safely and effectively in consultation with a specialist and 32
the provider engages in such consultation; and 33
(d) The services described in NRS 639.28085, when provided 34
by a pharmacist who participates in the health benefit plan of the 35
carrier. 36
2. A carrier that offers or issues a health benefit plan shall 37
reimburse: 38
(a) A pharmacist who participates in the health benefit plan of 39
the carrier for the services described in NRS 639.28085 at a rate 40
equal to the rate of reimbursement provided to a physician, 41
physician assistant or advanced practice registered nurse for similar 42
services. 43
(b) An advanced practice registered nurse or a physician 44
assistant who participates in the network plan of the carrier for any 45
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service to test for, prevent or treat human immunodeficiency virus 1
or hepatitis C at a rate equal to the rate of reimbursement provided 2
to a physician for similar services. 3
3. A carrier shall not: 4
(a) Subject the benefits required by subsection 1 to medical 5
management techniques ; [, other than step therapy;] 6
(b) Limit the covered amount of a drug described in paragraph 7
(a) of subsection 1; 8
(c) Refuse to cover a drug described in paragraph (a) of 9
subsection 1 because the drug is dispensed by a pharmacy through 10
mail order service; or 11
(d) Prohibit or restrict access to any service or drug to treat 12
human immunodeficiency virus or hepatitis C on the same day on 13
which the insured is diagnosed. 14
4. A carrier shall ensure that the benefits required by 15
subsection 1 are made available to an insured through a provider of 16
health care who participates in the network plan of the carrier. 17
5. A health benefit plan subject to the provisions of this chapter 18
that is delivered, issued for delivery or renewed on or after 19
January 1, [2024,] 2026, has the legal effect of including the 20
coverage required by subsection 1, and any provision of the plan 21
that conflicts with the provisions of this section is void. 22
6. As used in this section: 23
(a) “Medical management technique” means a practice which is 24
used to control the cost or use of health care services or prescription 25
drugs. The term includes, without limitation, the use of step therapy, 26
prior authorization and categorizing drugs and devices based on 27
cost, type or method of administration. 28
(b) “Network plan” means a health benefit plan offered by a 29
carrier under which the financing and delivery of medical care, 30
including items and services paid for as medical care, are provided, 31
in whole or in part, through a defined set of providers under contract 32
with the carrier. The term does not include an arrangement for the 33
financing of premiums. 34
(c) “Primary care” means the practice of family medicine, 35
pediatrics, internal medicine, obstetrics and gynecology and 36
midwifery. 37
(d) “Provider of health care” has the meaning ascribed to it in 38
NRS 629.031. 39
Sec. 4. NRS 695A.1843 is hereby amended to read as follows: 40
695A.1843 1. A society that offers or issues a benefit 41
contract shall include in the benefit 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
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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 society; 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 services described in NRS 639.28085, when provided 15
by a pharmacist who participates in the network plan of the society. 16
2. A society that offers or issues a benefit contract shall 17
reimburse: 18
(a) A pharmacist who participates in the network plan of the 19
society for the services described in NRS 639.28085 at a rate equal 20
to 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 society for any 24
service to test for, prevent or treat human immunodeficiency virus 25
or hepatitis C at a rate equal to the rate of reimbursement provided 26
to a physician for similar services. 27
3. A society shall not: 28
(a) Subject the benefits required by subsection 1 to medical 29
management techniques ; [, other than step therapy;] 30
(b) Limit the covered amount of a drug described in paragraph 31
(a) of subsection 1; 32
(c) Refuse to cover a drug described in paragraph (a) of 33
subsection 1 because the drug is dispensed by a pharmacy through 34
mail order service; or 35
(d) Prohibit or restrict access to any service or drug to treat 36
human immunodeficiency virus or hepatitis C on the same day on 37
which the insured is diagnosed. 38
4. A society shall ensure that the benefits required by 39
subsection 1 are made available to an insured through a provider of 40
health care who participates in the network plan of the society. 41
5. A benefit contract subject to the provisions of this chapter 42
that is delivered, issued for delivery or renewed on or after 43
January 1, [2024,] 2026, has the legal effect of including the 44
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coverage required by subsection 1, and any provision of the plan 1
that conflicts with the provisions of this section is void. 2
6. As used in this section: 3
(a) “Medical management technique” means a practice which is 4
used to control the cost or use of health care services or prescription 5
drugs. The term includes, without limitation, the use of step therapy, 6
prior authorization and categorizing drugs and devices based on 7
cost, type or method of administration. 8
(b) “Network plan” means a benefit contract offered by a society 9
under which the financing and delivery of medical care, including 10
items and services paid for as medical care, are provided, in whole 11
or in part, through a defined set of providers under contract with the 12
society. The term does not include an arrangement for the financing 13
of premiums. 14
(c) “Primary care” means the practice of family medicine, 15
pediatrics, internal medicine, obstetrics and gynecology and 16
midwifery. 17
(d) “Provider of health care” has the meaning ascribed to it in 18
NRS 629.031. 19
Sec. 5. NRS 695B.1924 is hereby amended to read as follows: 20
695B.1924 1. A hospital or medical services corporation that 21
offers or issues a policy of health insurance shall include in the 22
policy coverage for: 23
(a) All drugs approved by the United States Food and Drug 24
Administration for preventing the acquisition of human 25
immunodeficiency virus or treating human immunodeficiency virus 26
or hepatitis C in the form recommended by the prescribing 27
practitioner, regardless of whether the drug is included in the 28
formulary of the hospital or medical services organization; 29
(b) Laboratory testing that is necessary for therapy using a drug 30
to prevent the acquisition of human immunodeficiency virus; 31
(c) Any service to test for, prevent or treat human 32
immunodeficiency virus or hepatitis C provided by a provider of 33
primary care if the service is covered when provided by a specialist 34
and: 35
(1) The service is within the scope of practice of the provider 36
of primary care; or 37
(2) The provider of primary care is capable of providing the 38
service safely and effectively in consultation with a specialist and 39
the provider engages in such consultation; and 40
(d) The services described in NRS 639.28085, when provided 41
by a pharmacist who participates in the network plan of the hospital 42
or medical services corporation. 43
2. A hospital or medical services corporation that offers or 44
issues a policy of health insurance shall reimburse: 45
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(a) A pharmacist who participates in the network plan of the 1
hospital or medical services corporation for the services described in 2
NRS 639.28085 at a rate equal to the rate of reimbursement 3
provided to a physician, physician assistant or advanced practice 4
registered nurse for similar services. 5
(b) An advanced practice registered nurse or a physician 6
assistant who participates in the network plan of the hospital or 7
medical services corporation for any service to test for, prevent or 8
treat human immunodeficiency virus or hepatitis C at a rate equal to 9
the rate of reimbursement provided to a physician for similar 10
services. 11
3. A hospital or medical services corporation shall not: 12
(a) Subject the benefits required by subsection 1 to medical 13
management techniques ; [, other than step therapy;] 14
(b) Limit the covered amount of a drug described in paragraph 15
(a) of subsection 1; 16
(c) Refuse to cover a drug described in paragraph (a) of 17
subsection 1 because the drug is dispensed by a pharmacy through 18
mail order service; or 19
(d) Prohibit or restrict access to any service or drug to treat 20
human immunodeficiency virus or hepatitis C on the same day on 21
which the insured is diagnosed. 22
4. A hospital or medical services corporation shall ensure that 23
the benefits required by subsection 1 are made available to an 24
insured through a provider of health care who participates in the 25
network plan of the hospital or medical services corporation. 26
5. A policy of health insurance subject to the provisions of this 27
chapter that is delivered, issued for delivery or renewed on or after 28
January 1, [2024,] 2026, has the legal effect of including the 29
coverage required by subsection 1, and any provision of the policy 30
that conflicts 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 policy of health insurance offered 38
by a hospital or medical services corporation under which the 39
financing and delivery of medical care, including items and services 40
paid for as medical care, are provided, in whole or in part, through a 41
defined set of providers under contract with the hospital or medical 42
services corporation. The term does not include an arrangement for 43
the financing of premiums. 44
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(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. 6. NRS 695C.1743 is hereby amended to read as follows: 6
695C.1743 1. A health maintenance organization that offers 7
or issues a health care plan shall include in the plan coverage for: 8
(a) All drugs approved by the United States Food and Drug 9
Administration for preventing the acquisition of human 10
immunodeficiency virus or treating human immunodeficiency virus 11
or hepatitis C in the form recommended by the prescribing 12
practitioner, regardless of whether the drug is included in the 13
formulary of the health maintenance organization; 14
(b) Laboratory testing that is necessary for therapy that uses a 15
drug to prevent the acquisition of human immunodeficiency virus; 16
(c) Any service to test for, prevent or treat human 17
immunodeficiency virus or hepatitis C provided by a provider of 18
primary care if the service is covered when provided by a specialist 19
and: 20
(1) The service is within the scope of practice of the provider 21
of primary care; or 22
(2) The provider of primary care is capable of providing the 23
service safely and effectively in consultation with a specialist and 24
the provider engages in such consultation; and 25
(d) The services described in NRS 639.28085, when provided 26
by a pharmacist who participates in the network plan of the health 27
maintenance organization. 28
2. A health maintenance organization that offers or issues a 29
health care plan shall reimburse: 30
(a) A pharmacist who participates in the network plan of the 31
health maintenance organization for the services described in NRS 32
639.28085 at a rate equal to the rate of reimbursement provided to a 33
physician, physician assistant or advanced practice registered nurse 34
for similar services. 35
(b) An advanced practice registered nurse or a physician 36
assistant who participates in the network plan of the health 37
maintenance organization for any service to test for, prevent or treat 38
human immunodeficiency virus or hepatitis C at a rate equal to the 39
rate of reimbursement provided to a physician for similar services. 40
3. A health maintenance organization shall not: 41
(a) Subject the benefits required by subsection 1 to medical 42
management techniques ; [, other than step therapy;] 43
(b) Limit the covered amount of a drug described in paragraph 44
(a) of subsection 1; 45
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(c) Refuse to cover a drug described in paragraph (a) of 1
subsection 1 because the drug is dispensed by a pharmacy through 2
mail order service; or 3
(d) Prohibit or restrict access to any service or drug to treat 4
human immunodeficiency virus or hepatitis C on the same day on 5
which the enrollee is diagnosed. 6
4. A health maintenance organization shall ensure that the 7
benefits required by subsection 1 are made available to an enrollee 8
through a provider of health care who participates in the network 9
plan of the health maintenance organization. 10
5. A health care plan subject to the provisions of this chapter 11
that is delivered, issued for delivery or renewed on or after 12
January 1, [2024,] 2026, has the legal effect of including the 13
coverage required by subsection 1, and any provision of the plan 14
that conflicts with the provisions of this section is void. 15
6. As used in this section: 16
(a) “Medical management technique” means a practice which is 17
used to control the cost or use of health care services or prescription 18
drugs. The term includes, without limitation, the use of step therapy, 19
prior authorization and categorizing drugs and devices based on 20
cost, type or method of administration. 21
(b) “Network plan” means a health care plan offered by a health 22
maintenance organization under which the financing and delivery of 23
medical care, including items and services paid for as medical care, 24
are provided, in whole or in part, through a defined set of providers 25
under contract with the health maintenance organization. The term 26
does not include an arrangement for the financing of premiums. 27
(c) “Primary care” means the practice of family medicine, 28
pediatrics, internal medicine, obstetrics and gynecology and 29
midwifery. 30
(d) “Provider of health care” has the meaning ascribed to it in 31
NRS 629.031. 32
Sec. 7. NRS 695G.1705 is hereby amended to read as follows: 33
695G.1705 1. A managed care organization that offers or 34
issues a health care plan shall include in the plan coverage for: 35
(a) All drugs approved by the United States Food and Drug 36
Administration for preventing the acquisition of human 37
immunodeficiency virus or treating human immunodeficiency virus 38
or hepatitis C in the form recommended by the prescribing 39
practitioner, regardless of whether the drug is included in the 40
formulary of the managed care organization; 41
(b) Laboratory testing that is necessary for therapy that uses a 42
drug to prevent the acquisition of human immunodeficiency virus; 43
(c) Any service to test for, prevent or treat human 44
immunodeficiency virus or hepatitis C provided by a provider of 45
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primary care if the service is covered when provided by a specialist 1
and: 2
(1) The service is within the scope of practice of the provider 3
of primary care; or 4
(2) The provider of primary care is capable of providing the 5
service safely and effectively in consultation with a specialist and 6
the provider engages in such consultation; and 7
(d) The services described in NRS 639.28085, when provided 8
by a pharmacist who participates in the network plan of the 9
managed care organization. 10
2. A managed care organization that offers or issues a health 11
care plan shall reimburse: 12
(a) A pharmacist who participates in the network plan of the 13
managed care organization for the services described in NRS 14
639.28085 at a rate equal to the rate of reimbursement provided to a 15
physician, physician assistant or advanced practice registered nurse 16
for similar services. 17
(b) An advanced practice registered nurse or a physician 18
assistant who participates in the network plan of the managed care 19
organization for any service to test for, prevent or treat human 20
immunodeficiency virus or hepatitis C at a rate equal to the rate of 21
reimbursement provided to a physician for similar services. 22
3. A managed care organization shall not: 23
(a) Subject the benefits required by subsection 1 to medical 24
management techniques ; [, other than step therapy;] 25
(b) Limit the covered amount of a drug described in paragraph 26
(a) of subsection 1; 27
(c) Refuse to cover a drug described in paragraph (a) of 28
subsection 1 because the drug is dispensed by a pharmacy through 29
mail order service; or 30
(d) Prohibit or restrict access to any service or drug to treat 31
human immunodeficiency virus or hepatitis C on the same day on 32
which the insured is diagnosed. 33
4. A managed care organization shall ensure that the benefits 34
required by subsection 1 are made available to an insured through a 35
provider of health care who participates in the network plan of the 36
managed care organization. 37
5. A health care plan subject to the provisions of this chapter 38
that is delivered, issued for delivery or renewed on or after 39
January 1, [2024,] 2026, has the legal effect of including the 40
coverage required by subsection 1, and any provision of the plan 41
that conflicts with the provisions of this section is void. 42
6. As used in this section: 43
(a) “Medical management technique” means a practice which is 44
used to control the cost or use of health care services or prescription 45
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drugs. The term includes, without limitation, the use of step therapy, 1
prior authorization and categorizing drugs and devices based on 2
cost, type or method of administration. 3
(b) “Network plan” means a health care plan offered by a 4
managed care organization under which the financing and delivery 5
of medical care, including items and services paid for as medical 6
care, are provided, in whole or in part, through a defined set of 7
providers under contract with the managed care organization. The 8
term does not include an arrangement for the financing of 9
premiums. 10
(c) “Primary care” means the practice of family medicine, 11
pediatrics, internal medicine, obstetrics and gynecology and 12
midwifery. 13
(d) “Provider of health care” has the meaning ascribed to it in 14
NRS 629.031. 15
Sec. 8. NRS 422.403 is hereby amended to read as follows: 16
422.403 1. The Department shall, by regulation, establish and 17
manage the use by the Medicaid program of step therapy and prior 18
authorization for prescription drugs. 19
2. The Drug Use Review Board shall: 20
(a) Advise the Department concerning the use by the Medicaid 21
program of step therapy and prior authorization for prescription 22
drugs; 23
(b) Develop step therapy protocols and prior authorization 24
policies and procedures for use by the Medicaid program for 25
prescription drugs; and 26
(c) Review and approve, based on clinical evidence and best 27
clinical practice guidelines and without consideration of the cost of 28
the prescription drugs being considered, step therapy protocols used 29
by the Medicaid program for prescription drugs. 30
3. The step therapy protocol established pursuant to this section 31
must not apply to [a] : 32
(a) A drug approved by the Food and Drug Administration that 33
is prescribed to treat a psychiatric condition of a recipient of 34
Medicaid, if: 35
[(a)] (1) The drug has been approved by the Food and Drug 36
Administration with indications for the psychiatric condition of the 37
insured or the use of the drug to treat that psychiatric condition is 38
otherwise supported by medical or scientific evidence; 39
[(b)] (2) The drug is prescribed by: 40
[(1)] (I) A psychiatrist; 41
[(2)] (II) A physician assistant under the supervision of a 42
psychiatrist; 43
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[(3)] (III) An advanced practice registered nurse who has 1
the psychiatric training and experience prescribed by the State 2
Board of Nursing pursuant to NRS 632.120; or 3
[(4)] (IV) A primary care provider that is providing care to 4
an insured in consultation with a practitioner listed in [subparagraph 5
(1), (2)] sub-subparagraph (I), (II) or [(3),] (III), if the closest 6
practitioner listed in [subparagraph (1), (2)] sub-subparagraph (I), 7
(II) or [(3)] (III) who participates in Medicaid is located 60 miles or 8
more from the residence of the recipient; and 9
[(c)] (3) The practitioner listed in [paragraph (b)] subparagraph 10
(2) who prescribed the drug knows, based on the medical history of 11
the recipient, or reasonably expects each alternative drug that is 12
required to be used earlier in the step therapy protocol to be 13
ineffective at treating the psychiatric condition [.] ; or 14
(b) A drug that is used to prevent the acquisition of human 15
immunodeficiency virus or treat human immunodeficiency virus 16
or hepatitis C. 17
4. The Department shall not require the Drug Use Review 18
Board to develop, review or approve prior authorization policies or 19
procedures necessary for the operation of the list of preferred 20
prescription drugs developed pursuant to NRS 422.4025. 21
5. The Department shall accept recommendations from the 22
Drug Use Review Board as the basis for developing or revising step 23
therapy protocols and prior authorization policies and procedures 24
used by the Medicaid program for prescription drugs. 25
6. As used in this section: 26
(a) “Medical or scientific evidence” has the meaning ascribed to 27
it in NRS 695G.053. 28
(b) “Step therapy protocol” means a procedure that requires a 29
recipient of Medicaid to use a prescription drug or sequence of 30
prescription drugs other than a drug that a practitioner recommends 31
for treatment of a psychiatric condition of the recipient before 32
Medicaid provides coverage for the recommended drug. 33
Sec. 9. The provisions of NRS 354.599 do not apply to any 34
additional expenses of a local government that are related to the 35
provisions of this act. 36
Sec. 10. 1. This section becomes effective upon passage and 37
approval. 38
2. Sections 1 to 9, inclusive, of this act become effective: 39
(a) Upon passage and approval for the purpose of adopting any 40
regulations and performing any other preparatory administrative 41
tasks that are necessary to carry out the provisions of this act; and 42
(b) On January 1, 2026, for all other purposes. 43
H