SB 378 — Revises provisions relating to prescription drugs. (BDR 18-574)

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(a)232.320 Shall.1.

appoint,ctwith the consent of the Governor, administrators of the divisions of the Department, who are respec(1) The AdministratorDirector: of the Aging and Disability Services Division;

(a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows:

(1) The Administrator of the Aging and Disability Services Division;

- 80th Session (2019) – 3 – (b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and sections 31.05 to 31.2, inclusive, of this act, 422.580, 432.010 to 432.133, inclusive, 432B.621 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of - *SB378_R2* – 4 – the Department, but is not responsible for the clinical activities of theactivities Division of Publicthe andother Behavioraldivisions.ral Health or the professional line activities(c) ofShall administer any state program for persons with developmental disabilities established pursuant to the otherDevelopmental divisions.Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C.

(c) Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C.

(4) Identify the sources of funding for services provided by the Dep(5) Set forth sufficient information to assist the Department in providing those services and in the allocationplanning and budgeting for the future provision of thatthose funding;services;

(5)and Set(6) forthContain sufficientany other information tonecessary assistfor the Department futureto provisioncommunicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of thosefederal services;money and any need for the modification of programs administered by the Department.

andplanning(e) May, by regulation, require nonprofit organizations and budgetingstate forand thelocal (6)governmental Containagencies anyto otherprovide information necessaryregarding for the Governmentprograms concerningof demographicthose trends,organizations formulasand foragencies, theederalexcluding distributiondetailed ofinformation federalrelating moneyto their budgets and anypayrolls, needwhich the - 80th Session (2019) – 4 – Director deems necessary for the modificationperformance of programsthe administeredduties byimposed theupon Department.him or her pursuant to this section.

(e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

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(Deleted by amendment.) Sec.241.016 1.

27.The meetings of a public body that are quasi-s:

(Deletedjudicial byin amendment.)nature -are *SB378_R2*subject –to 5the –provisions Sec.of this chapter.

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NRS 241.016 is hereby amended to read as follows:

241.016 1.

The meetings of a public body that are quasi- judicial in nature are subject to the provisions of this chapter.

Any provision of law, including, without limitation, NRS 91.270, 219A.210, 228.495, 239C.140, 281A.350, 281A.690, 281A.735, 281A.760, 284.3629, 286.150, 287.0415, 287.04345, 287.338, 288.220, 289.387, 295.121, 360.247, 388.261, 388A.495, 388C.150, 388G.710, 388G.730, 392.147, 392.467, 394.1699, 396.3295, 422.405, 433.534, 435.610, 463.110, 622.320, 622.340, 630.311, 630.336, 631.3635, 639.050, 642.518, 642.557, 686B.170, 696B.550,696(a) 703.196Provides andthat 706.1725,any which:meeting, hearing or other proceeding is not subject to the provisions of this chapter;

(a)or Provides(b) thatOtherwise anyauthorizes or requires a closed meeting, hearing or otherproceeding, proceeding isprevails notover subject to the general provisions of this chapter;chapter.

or4. or proceeding,se authorizes or requires a closed meeting, hearing  prevails over the general provisions of this chapter.

The exceptions provided to this chapter, and electronic communication, must not be used to circumvent the spirit or letter of this chapter to deliberate or act, outside of an open and public meeting, upon a matter over which the public body has supervision, control, jurisdiction or advisory powers.

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A governing body of a county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada that provides coverage of prescription drugs pursuant to NRS 287.010 or any issuer of a policy of health insurance purchased pursuant to NRS 287.010 may use the list of preferred prescription drugs developed by the Department of Health and Human Services pursuant to subsection 1 of NRS 422.4025 as its formulary and obtain prescription drugs through the purchasing agreements negotiated by the Department pursuant to that section by notifying the Department in the form prescribed by the Department.

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287.040 The provisions of NRS 287.010 to 287.040, inclusive, and section 28.5 of this act do not make it compulsory upon any governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada, except as otherwise provided in NRS 287.021 or subsection 4 of NRS 287.023 or in an agreement entered into pursuant to subsection 3 of NRS 287.015, to pay any premiums, contributions or other costs for group insurance, a plan of benefits or medical or hospital services established pursuant to NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or (d) of subsection 1 of NRS 287.025, for coverage under the Public Employees’ Benefits Program, or to make any contributions to a trust fund established pursuant to NRS 287.017, or upon any officer or employee of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of this State to accept any such coverage or to assign his ororl her wages or salary in payment of premiums or contributions therefor.

The Board may establish a plan of life, accident or health insurance and provide for the payment of contributions into the Program Fund, a schedule of benefits and the disbursement of benefits from the Program Fund.

The Board may reinsure anyementany risk or any part of such a risk.

pursuant2. to this section, the Board or any entity with which the Board enters into a contract to provide such coverage may use the list of preferred prescription drugs developed by the Department of Health and Human Services pursuant to subsection 1 of NRS 422.4025 as its formulary and obtain prescription drugs through the purchasing agreements negotiated by the Department pursuant to that section by notifying the Department in the form prescribed by the Department.

If the Board provides coverage of prescription drugs pursuant to this section, the Board or any entity with which the Board enters into a contract to provide such coverage may use the - 80th Session (2019) – 6 – list of preferred prescription drugs developed by the Department of Health and Human Services pursuant to subsection 1 of NRS 422.4025 as its formulary and obtain prescription drugs through the purchasing agreements negotiated by the Department pursuant to that section by notifying the Department in the form prescribed by the Department.

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Chapter 422 of NRS is hereby amended by adding thereto the provisions set forth as sections 31.05 to 31.2, inclusive, of thisSec. act.

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(b) A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 for recipients of Medicaid or recipients of insurance through the Children’s Health Insurance Program who receive coverage through a Medicaid managed care program.program.ho receive 3.

3.

and (b) Require the pharmacy benefit manager or health maintenance organization, as applicable, to disclose to the Department any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid and any fees and charges imposed by the pharmacyespharmacy collected benefit manager or health maintenance organization pursuant to the4.onIn addition to meeting the requirementscontract. of subsection 3, a contract entered into pursuant to:

- 80th Session (2019) – 7 – 4.

In addition to meeting the requirements of subsection 3, a contract entered into pursuant to:

(b) Paragraph (b) of subsection 2 must require the health maintenance organization to provide to the Department the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, less an administrative fee in an amount prescribed by the contract.

Any contract between the Department and a pharmacy benefit manager or health maintenance organization entered into pursuant to section 31.15 of this act must require the - *SB378_R2* – 8 – pharmacy benefit manager or health maintenance organization, as applicable, to:

(b) Obtain from an independent accountant, at the expense of the pharmacy benefit manager or health maintenance organization, as applicable, an annual audit of internal controls to ensure the integrity of financial transactions and claimsclaimscontrols to processing.

422.401 As used in NRS 422.401 to 422.406, inclusive, and sections 31.05 to 31.2, inclusive of this act, unless the context otherwise requires, the words and terms defined in NRS 422.4015 and 422.402 and sections 31.05 and 31.1 of this act have the meaSec.meanings ascribed to them in those sections.

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422.4015 [“Committee”] “Board” means the [Pharmacy and Therapeutics Committee] Silver State Scripts Board established pursuant to NRS 422.4035.

(a) By regulation, develop a list of preferred prescription drugs to be used for the Medicaid program [.] and the Children’s Health Insurance Program, and each public or nonprofit health benefitbenefitlth plan that elects to use the list of preferred prescription drugs as its formulary pursuant to NRS 287.0433 or section 28.5 or 33 of this act;

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(b)] Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus or acquired immunodeficiencyimmunodeficiencyent of syndrome, including, without limitation, protease inhibitors and antiretroviral medications;

on- the80th listSession of(2019) preferred– prescription9 drugs– and(a) isWhether excludeda fromclass anyof restrictionstherapeutic that are imposed by the Medicaid program on drugs that are(b) Which therapeutically equivalent prescription drugs willis beincluded reviewed for inclusion on the list of preferred prescription drugs and foris exclusionexcluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;

and(b) (c) Which therapeutically equivalent prescription drugs shouldwill be excludedreviewed for inclusion on the list of preferred prescription drugs and for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugsdrugs; based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.

and restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.

- *SB378_R2* – 10 – (a) Compile a report concerning the agreements negotiated pursuant to paragraph (b) of subsection 1 and contracts entered into pursuant to section 31.15 of this act which must include, without limitation, the financial effects of obtaining prescription drugs through those agreements and contracts, in total and aggregated separately for agreements negotiated by the Department, contracts with a pharmacy benefit manager and contractscon(b) withPost athe healthreport maintenanceon organization;an Internet website maintained by the Department and submit the report to the Director of the Legislative Counsel Bureau for transmittal to:

and (b) Post the report on an Internet website maintained by the Department and submit the report to the Director of the Legislative Counsel Bureau for transmittal to:

- 80th Session (2019) – 10 – (a) Advise the Department concerning the use by the Medicaid program of step therapy and prior authorization for prescription drugs;

(b) Develop step therapy protocols and prior authorization policies and procedures for use by the Medicaid program for prescription drugs;

and for use by the Medicaid program for (c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols usedfused by the3. Medicaid program for prescription drugs.

3.

The [Committee] Board must consist of [at least 5] - *SB378_R2* – 11 – such members [and not more than 11 members] as are appointed by the [Governor based on recommendations from the] Director.

The [Governor] Director shall appoint to the [Committee] Board health care professionals who have knowledge and expertise in one(a) orThemoreclinicallyllappropriate moreprescribing of theoutpatient following:prescription drugs that are covered by Medicaid;

(a) The clinically appropriate prescribing of outpatient prescription drugs that are covered by Medicaid;

At least one-third of the members of the [Committee] Board must be either active pharmacists registered - 80th Session (2019) – 11 – in this State or persons in this State with doctoral degrees in pharmacy.

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31.6.

NRS 422.404 is hereby amended to read as follows:

The [Governor] Director shall appoint the Chairs:Chair of the [Committee] Board from among its members.

of the [Committee] Board from among its members.

A member may be reappointed.freappointed. the 3.

the 3.

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Each member of the [Committee] Board who is an officer or employee of the State of Nevada or a local government must be relieved from his or her duties without loss of regular compensation so that the person may prepare for and attend meetings of the [Committee] Board and perform any work necessary to carry out the duties of the [Committee] Board in the most timely manner practicable.

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(a) Identifying the prescription drugs which should be included on the list of preferred prescription drugs developed by the Department [for the Medicaid program] pursuant to NRS 422.4025 [and] , which must include, without limitation, any prescription drug required by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to be covered by the Medicaid program and any other prescriptionprescriptionto dru(b)drug Identifyingdeemed theessential prescription drugs which should be excluded from any restrictions that are imposed by the MedicaidBoard; program on dru[(b)] (c) Identifying classes of therapeutic prescription drugs for its review and performing a clinical analysis of each drug included in each class that is identified for review;

(b) Identifying the prescription drugs which should be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;

[(b)] (c) Identifying classes of therapeutic prescription drugs for its review and performing a clinical analysis of each drug included in each class that is identified for review;

(b) Review new pharmaceutical products in as expeditious a manner as possible;

andandaceutical products in as expeditious a (c) Consider new clinical evidence supporting the inclusion of an existing pharmaceutical product on the list of preferred - *SB378_R2* – 13 – prescription drugs developed by the Department [for the Medicaid program] and new clinical evidence supporting the exclusion of an existing pharmaceutical product from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs in as expeditious a manner as possible.

and - 80th Session (2019) – 13 – (b) Establish subcommittees to analyze specific issues that arise as the [Committee] Board carries out its duties.

(a)(b) AdoptEnter regulations;into contracts for any services.

and (b) Enter into contracts for any services.

Any regulations adopted by the Department pursuant to NRS 422.27172 to 422.27178, inclusive, and 422.401 to 422.406, inclusive, and sections 31.05 to 31.2, inclusive, of this act must be adopted in accordance with the provisions of chapter 241 of NRS.stNRS. be Sec.

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NRS32.5. 683A.178 is hereby amended to read as 683A.178 1.

NRS 683A.178 is hereby amended to read as follows:

683A.178 1.

A pharmacy benefit manager shall notify [the] a third party with which it has entered into a contract in writing of any activity, policy or practice of the pharmacy benefit manager that presents a conflict of interest that interferes with the [ability of the pharmacy benefitimposed managerby tosubsection discharge1.arge that fiduciary duty.] obligations imposedSec. by subsection 1.

Sec.

A nonprofit health benefit plan may use the list of preferred prescription drugs developed by the Department of - *SB378_R2* – 14 – Health and Human Services pursuant to subsection 1 of NRS 422.4025 as its formulary and obtain prescription drugs through the purchasing agreements negotiated by the Department pursuant to that section by notifying the Department in the form prescribed by the Department.

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Notwithstanding any other provision of law, the terms of the members appointed to the Pharmacy and Therapeutics Committee established pursuant to NRS 422.4035, as that section exists on June 30, 2019, expire on that date.

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1.regulations and performing any other preparatory administrativeny tasks that are necessary to carry out the provisions of this act;

Upon passage and approval2. for the purpose of adopting any regulations and performing any other preparatory administrative tas2.

tOnOn January 1, 2020, for all other purposes.nspurposes. of this act;

and~~~~~ H19 - *SB378_R2*80th Session (2019)