Nevada
SB354
SB354 - Revises provisions relating to health insurance coverage of prescription drugs. (BDR 57-1041)
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EXEMPT
(Reprinted with amendments adopted on April 21, 2025)
FIRST REPRINT
S.B. 354
-
*SB354_R1*
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.
~
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 the
1
Public Employees’ Benefits Program, to cover: (1) drugs that prevent the
2
acquisition
of
human
immunodeficiency
virus
or
that
treat
human
3
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 287.04335, 689A.0437, 689B.0312,
6
689C.1671, 695A.1843, 695B.1924, 695C.050, 695C.1743, 695G.1705) Existing
7
law prohibits such health plans from implementing any medical management
8
techniques on the coverage of such drugs or services, except the use of step
9
therapy. (NRS 287.010, 287.04335, 689A.0437, 689B.0312, 689C.1671,
10
695A.1843, 695B.1924, 695C.050, 695C.1743, 695G.1705) Sections 1-7 of this
11
bill remove the exemption for step therapy for private health plans, thereby
12
prohibiting such health plans from requiring step therapy before providing coverage
13
for a drug that: (1) prevents the acquisition of human immunodeficiency virus; or
14
(2) treats human immunodeficiency virus or hepatitis C. Sections 6-8.5 of this bill
15
authorize the Public Employees’ Benefits Program and Medicaid managed care
16
– 2 –
-
*SB354_R1*
organizations to continue requiring the use of step therapy for coverage of such
17
drugs as a medical management technique.
18
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
– 3 –
-
*SB354_R1*
(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,] 2027, 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
– 4 –
-
*SB354_R1*
(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,] 2027, 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
– 5 –
-
*SB354_R1*
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
– 6 –
-
*SB354_R1*
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,] 2027, 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.
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