SB 325 — Establishes provisions relating to preventing the acquisition of human immunodeficiency virus. (BDR 54-632)

- 81st Session (2021) – 5 – (a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on thethections insurance.

Any contract withCommissionerpendeof anaInsurancetorasusttoe independenttherovreasonableness administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided.

- *SB325_R1* – 6 – (d) Defray part or all of the cost of maintenance of a self- insurance fund or of the premiums upon insurance.

- 81st Session (2021) – 6 – 2.

If the amount of the deductions from compensation required to pay for the group insurance exceeds the compensation to which a trustee is entitled, the difference must be paid by the trustee.

and (b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which theythe5.autA authorizecontract thethat purchase.is entered into pursuant to subsection 3:

5.

A contract that is entered into pursuant to subsection 3:

- *SB325_R1* – 7 – Sec.

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 687B.409, 689B.255, 695G.150, 695G.155, 695G.160, 695G.162, - 81st Session (2021) – 7 – 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.170 to 695G.174, inclusive, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, and section 20 of this act in the same manner as an insurer that is licensed pursuant to titletitSec. 57 of NRS is required to comply with those provisions.

Sec.6.f NChapter 422 of NRS is hereby amended by adding.

6.thereto a new section to read as follows:

Chapter 422 of NRS is hereby amended by adding thereto a new section to read as follows:

and (b) Negotiate and enter into agreements to purchase the drugs included on the list of preferred prescription drugs on behalf of the health benefit plans described in paragraph (a) or enter into aaof the contract pursuant to NRS 422.4053 with a pharmacy benefit manager or health maintenance organization, as appropriate, to negotiate such agreements.

(a) Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus or acquired immunodeficiency - *SB325_R1* – 8 – syndrome, including, without limitation, protease inhibitors and antiretroviral medications;

(c)- Antihemophilic81st medications;Session (2021) – 8 – (d) Any prescription drug which the Board identifies as appropriate for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs.

and (d) Any prescription drug which the Board identifies as appropriate for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs.

and (c) Which prescription drugs should be excluded from any 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.

6.(a) Compile a report concerning the agreements negotiated shall:

Onpursuant orto beforeparagraph February(b) of subsection 1 and contracts entered into pursuant to NRS 422.4053 which must include, without limitation, the financial effects of eachobtaining year,prescription drugs through those agreements and contracts, in total and aggregated separately for agreements negotiated by the DepartmentDepartment, shall:contracts with a pharmacy benefit manager and contracts with a health maintenance organization;

(a)and Compile- a81st reportSession concerning(2021) the– agreements9 negotiated– pursuantDepartment to paragraph (b) of subsection 1 and contractssubmit enteredthe intoreport pursuant to NRS 422.4053 which must include, without limitation, the financialDirector effects of obtainingthe prescriptionLegislative drugsCounsel throughBureau those agreements and contracts, in total and aggregated separately for agreementstransmittal negotiatedto: by the Department, contracts with a pharmacy benefit manager and contracts with a health maintenance organization;

and - *SB325_R1* – 9 – (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:

NRS(Deleted 422.403by isamendment.) herebySec. amended to read as follows:

422.403 1.

The Department shall, by regulation, establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.

2.

The Drug Use Review Board shall:

(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 (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 used by the Medicaid program for prescription drugs.

3.

The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed pursuant to NRS 422.4025.

4.

The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.

5.

The Department shall not require a recipient of Medicaid to undergo step therapy for a prescription drug for the prevention of human immunodeficiency virus.

Sec.

(b) Penalize a pharmacist or pharmacy for providing the informationalternative describedor ingeneric paragraphdrug (a)to ora sellingcovered person;g a less expensive alternative(c) Prohibit a pharmacy from offering or genericproviding drugdelivery services directly to a covered person;person as an ancillary service of the pharmacy;

- *SB325_R1* – 10 – (c) Prohibit a pharmacy from offering or providing delivery services directly to a covered person as an ancillary service of the pharmacy;

(b) Do not apply to an institutional pharmacy, as defined in NRS 639.0085,employee or aindependent pharmacistcontractor.n working in such a pharmacy as an employee3. or independent contractor.

3.

NRS(Deleted 687B.225by isamendment.) hereby- amended81st toSession read(2021) as– follows:10 – Sec.

687B.225 1.

Except as otherwise provided in NRS 689A.0405, 689A.0413, 689A.044, 689A.0445, 689B.031, 689B.0313, 689B.0317, 689B.0374, 695B.1912, 695B.1914, 695B.1925, 695B.1942, 695C.1713, 695C.1735, 695C.1745, 695C.1751, 695G.170, 695G.171 and 695G.177, and sections 10, 12, 13, 15, 16 and 19 of this act, any contract for group, blanket or individual health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization for that care from the insurer or organization.

The insurer or organization shall:

(a) File its procedure for obtaining approval of care pursuant to this section for approval by the Commissioner;

and (b) Respond to any request for approval by the insured or member pursuant to this section within 20 days after it receives the request.

2.

The procedure for prior authorization may not discriminate among persons licensed to provide the covered care.

- *SB325_R1* – 11 – Sec.

(a) Any drug approved by the United States Food and Drug Administration forforved preventingbpreventing thethetateacquisition acquisitionofg of human immunodeficiency virus;

An insurer shallmay notsubject require an insured to undergo step therapy or receive prior authorization in order to receive the benefits required by subsection 1.to reasonable medical management techniques.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the policy thattha6.coAs conflictsused within thethis provisionssection:ons of this section is void.

6.(a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.

AsThe usedterm inincludes, thiswithout section:limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration.

(a)(b) “Network plan” means a policy of health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer.

(b)(c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

- 81st Session (2021) – 11 – Sec.

689A.330 If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public officer of that other state has informed the Commissioner that the policy is not subject to approval or disapproval by that officer, the Commissioner may by rulingrulingproval - *SB325_R1* – 12 – require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and section 10 of this act.

(a) AnyDrugs drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus;

An insurer shallmay notsubject require an insured to undergo step therapy or receive prior authorization in order to receive the benefits required by subsection 1.t4.

4.

(a) “Network“Medical plan”management technique” means a policypractice ofwhich groupis healthused insuranceto offeredcontrol by an insurer under which the financingcost andor deliveryuse of medicalhealth care,care including items and services paid for as medical care, are provided, in whole or inprescription part,drugs. through a defined set of providers under contract with the insurer.

The term doesincludes, notwithout includelimitation, anthe arrangementuse forof thestep financingtherapy, prior authorization and categorizing drugs and devices based on cost, type or method of premiums.administration.

- 81st Session (2021) – 12 – (b) “Network plan” means a policy of group health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of include an arrangement for the financing of premiums.oes not (c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

- *SB325_R1* – 13 – (a) AnyDrugs drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus;

A carrier shallmay notsubject requirethe anbenefits insuredrequired by subsection 1 to undergo4.asA stepcarrier therapyshall orensure receivethat priorthe authorizationbenefits inrequired orderby subsection 1 are made available to receivean insured through a provider of health care who participates in the benefitsnetwork requiredplan byof subsectionthe 1.carrier.

4.

A carrier shall ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the carrier.

(a) “Network“Medical plan”management technique” means a healthpractice benefitwhich planis offeredused byto acontrol carrier under which the financingcost andor deliveryuse of medicalhealth care,care including items and services paid for as medical care, are provided, in whole or inprescription part,drugs. through a defined set of providers under contract with the carrier.

The term doesincludes, notwithout includelimitation, anthe arrangementuse forof thestep financingtherapy, prior authorization and categorizing drugs and devices based on cost, type or method of premiums.administration.

- 81st Session (2021) – 13 – (b) “Network plan” means a health benefit plan offered by a carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers arrangement for the financing of premiums.does not include an (c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

- *SB325_R1* – 14 – (a) AnyDrugs drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus;

2.reimburse a pharmacist who participates in the network plan ofl the society for the services described in section 1 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A society that offers or issues a benefit contract shall reimburse a pharmacist who participates in the network plan of the society for the services described in section 1 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A society shallmay notsubject requirethe anbenefits insuredrequired toby undergosubsection step1 therapy or receive prior authorization in order to receivereasonable themedical benefitsmanagement requiredtechniques. by subsection 1.

- 81st Session (2021) – 14 – 6.

(a) “Network“Medical plan”management technique” means a benefitpractice contractwhich offeredis byused ato societycontrol under which the financingcost andor deliveryuse of medicalhealth care,care including items and services paid for as medical care, are provided, in whole or inprescription part,drugs. through a defined set of providers under contract with the society.

The term includes, without limitation, the use devices based on cost, type or method of administration.ugs and (b) “Network plan” means a benefit contract offered by a society under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the society.

(b)(c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(a) AnyDrugs drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus;

and - *SB325_R1* – 15 – (c) The services described in section 1 of this act, when provided by a pharmacist who participates in the network plan of the hospital or medical services corporation.

2.issues a policy of health insurance shall reimburse a pharmacist who participates in the network plan of the hospital or medical services corporation for the services described in section 1 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A hospital or medical services corporation that offers or issues a policy of health insurance shall reimburse a pharmacist who participates in the network plan of the hospital or medical services corporation for the services described in section 1 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A hospital or medical services corporation shallmay notsubject requirethe anbenefits insuredrequired toby undergosubsection step1 therapy or receive prior authorization in order to receivereasonable themedical benefitsmanagement requiredtechniques. by subsection 1.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or - 81st Session (2021) – 15 – after October 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.

(a)is “Networkused plan”to meanscontrol athe policycost of health insurance offered by a hospital or medicaluse services corporation under which the financing and delivery of medicalhealth care,care including items and services paid for as medical care, are provided, in whole or inprescription part,drugs. through a defined set of providers under contract with the hospital or medical services corporation.

The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration.

(b) “Network plan” means a policy of health insurance offered by a hospital or medical services corporation under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the hospital or medical services corporation.

(b)(c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(a) AnyDrugs drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus;

and (c) The services described in section 1 of this act, when provided by a pharmacist who participates in the network plan of the health maintenance organization.

- *SB325_R1* – 16 – 2.

A health maintenance organization shallmay notsubject requirethe anbenefits enrolleerequired toby undergosubsection step1 therapy or receive prior authorization in order to receivereasonable themedical benefitsmanagement requiredtechniques. by subsection 1.

- 81st Session (2021) – 16 – 5.

A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflictscon6.ictAs withused thein provisions of this sectionsection: is void.

6.this section is void.

As(a) “Medical management technique” means a practice which is used into thiscontrol section:the cost or use of health care services or prescription drugs.

(a)The “Networkterm plan”includes, meanswithout alimitation, health care plan offered by a health maintenance organization under which the financinguse and delivery of medicalstep care,therapy, includingprior itemsauthorization and servicescategorizing paiddrugs forand asdevices medicalbased care,on arecost, provided,type in whole or inmethod part, through a defined set of providersadministration. under contract with the health maintenance organization.

(b) “Network plan” means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the health maintenance organization.

(b)(c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

This provision does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a health maintenance org2.izaSolicitationzeofanenrolleesed byrsuant healths cmaintenance organization authorizedgranted anda regulatedcertificate pursuantof authority, or its representatives, must not be construed to thisviolate chapter.any provision of law relating to solicitation or advertising by practitioners of a healing art.

2.

Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to - *SB325_R1* – 17 – 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with - 81st Session (2021) – 17 – the Division of Health Care Financing and Policy of the Department of Health and Human Services.

5.695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17345,lusive, 695C.1735, 695C.1745 and 695C.1757 , and section 17 of this act apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

The provisions of NRS 695C.1694 to 695C.1698, inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17345, 695C.1735, 695C.1745 and 695C.1757 , and section 17 of this act apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

(c) The health care plan does not furnish comprehensive health carecar(d) servicesThe asCommissioner providedcertifies forthat inthe NRShealth 695C.060;maintenance organization:

(d) The Commissioner certifies that the health maintenance organization:

(f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to - *SB325_R1* – 18 – participate in matters relating to the content of programs pursuant to NRS 695C.110;

- 81st Session (2021) – 18 – (1) Resolving complaints in a manner reasonably to dispose of valid complaints;

and (2) Conducting external reviews of adverse determinations that comply with the provisions of NRS 695G.241 to 695G.310, inclusive;inc(h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;

(h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;

ItThe shallCommissioner engagemay, inby nowritten furtherorder, advertisingpermit orsuch solicitationfurtherf of any kind.

The Commissioner may, by written order, permit such further operation of the organization as the Commissioner may find to be in the best interest of enrollees to the end that enrollees are afforded the greatest practical opportunity to obtain continuing coverage for health care.

(a) AnyDrugs drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus;

- *SB325_R1* – 19 – (b) Laboratory testing that is necessary for therapy that uses such a drug;

and - 81st Session (2021) – 19 – (c) The services described in section 1 of this act, when provided by a pharmacist who participates in the network plan of the managed care organization.

A managed care organization that offers or issues a health care plan shall reimburse a pharmacist who participates in the network plan of the managed care organization for the services described in section 1 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A managed care organization shallmay notsubject requirethe anbenefits insuredrequired toby undergosubsection step1 therapy or receive prior authorization in order to receivereasonable themedical benefitsmanagement requiredtechniques. by subsection 1.

(a) “Network“Medical plan”management technique” means a healthpractice carewhich planis offeredused byto acontrol managed care organization under which the financingcost andor deliveryuse of medicalhealth care,care including items and services paid for as medical care, are provided, in whole or inprescription part,drugs. through a defined set of providers under contract with the managed care organization.

The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration.

managed care organization under which the financing andby a delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the managed care organization.

(b)(c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

- 81st Session (2021) – 20 – (a) Upon passage and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act;

H~~~~~ 21 - *SB325_R1*81st Session (2021)