SB 190 — Provides for the dispensing of self-administered hormonal contraceptives. (BDR 54-3)

AThe pharmacist must provide the risk assessment questionnaire prescribed by the State Board ofshall Healthadopt pursuantregulations tothat sectionprescribe: 8 of this act to a patient who requests a self-administered hormonal contraceptive before dispensing the self-administered hormonal contraceptive to the patient.

- 81st Session (2021) – 3 – (a) A risk assessment questionnaire that must be provided to a patient who requests a self-administered hormonal contraceptive pursuant to section 3 of this act.

(b) The information that must be provided in writing to a dispensed pursuant to section 3 of this act, which may include, without limitation, information concerning:

(1) The importance of obtaining recommended tests and screening from the patient’s attending provider or another qualified provider of health care who specializes in women’s health;

(2) The effectiveness of long-acting, reversible contraceptives as an alternative to self-administered hormonal contraceptives;

(3) When to seek emergency medical services as a result of administering a self-administered hormonal contraceptive;

and (4) The risk of contracting a sexually transmitted infection and ways to reduce that risk.

3.

As used in this section:

(a) “Attending provider” means a provider of health care who provides or has provided care to the patient.

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

Sec.

3.

1.

A pharmacist may dispense a self-administered hormonal contraceptive under the protocol established pursuant to section 2.5 of this act to a patient, regardless of whether the patient has obtained a prescription from a practitioner.

questionnaire prescribed by the Board pursuant to section 2.5 ofnt this act to a patient who requests a self-administered hormonal contraceptive before dispensing the self-administered hormonal contraceptive to the patient.

A pharmacist who dispenses a self-administered hormonal contraceptive under the standingprotocol order shall:

(a) Create a record concerning the dispensing of the self- administered hormonal contraceptive which includes, without limitation,- the81st nameSession of(2021) the– patient4 to– whom the self-administered hormonal contraceptive was dispensed, the type of self-self-ministered administered hormonal contraceptive dispensed and any other relevant information required by the protocol prescribed pursuant to section 82.5 of this act.

(1)(2) TheAny written recordinformation required by subsectionthe 4;regulations adopted pursuant to section 2.5 of this act.

and(d) (2)Comply Anywith written information required by the regulations adopted pursuant to section 82.5 of this act.act and any guidelines for dispensing the self- administered hormonal contraceptive recommended by the manufacturer.

(d)4. Comply with the regulations adopted pursuant to section 8 of this act and any guidelines for dispensing the self-administered hormonal contraceptive recommended by the manufacturer.

-A *SB190_R1*pharmacist –shall 4provide –to 4.any patient who requests a self-administered hormonal contraceptive under the protocol a written record of the request, regardless of whether the self- administered hormonal contraceptive is dispensed.

A pharmacist shall provide to any patient who requests a self-administered hormonal contraceptive under the standing order a written record of the request, regardless of whether the self-administered hormonal contraceptive is dispensed.

and (b) A written record of the self-administered hormonal contraceptive requested and any self-administered hormonal contraceptivecon5.acAny dispensed.pharmacy that wishes to dispense self-administered hormonal contraceptives under the protocol must notify the Board of that fact.

5.

Any pharmacy that wishes to dispense self-administered hormonal contraceptives under the standing order must notify the Board of that fact.

- 81st Session (2021) – 5 – (b) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

639.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 639.0015 to 639.016, inclusive, and section 2 of this act have the meanings ascribed to them in those sections.

[8.] (h) Development of written guidelines and protocols in collaboration with a practitioner which are intended for a patient in a - *SB190_R1* – 5 – licensed medical facility or in a setting that is affiliated with a medical facility where the patient is receiving care and whichwhichith a authorize collaborative drug therapy management.

639.210 The Board may suspend or revoke any certificate, license, registration or permit issued pursuant to this chapter, and - 81st Session (2021) – 6 – deny the application of any person for a certificate, license, registration or permit, if the holder or applicant:

3.any depressant drug or a controlled substance, unless taken pursuant to a lawfully issued prescription, while on duty in any establishment licensed by the Board;

Becomes or is intoxicated or under the influence of liquor, any depressant drug or a controlled substance, unless taken pursuant to a lawfully issued prescription, while on duty in any establishment licensed by the Board;

Has willfully made to the Board or its authorized representative any false statement which is material to the administration or enforcement of any of the provisions of this chapter;cha10.

- *SB190_R1* – 6 – 10.

- 81st Session (2021) – 7 – 13.

Has had a certificate, license or permit suspended or revoked in another state on grounds which would cause suspension or revocation of a certificate, license or permit in this State;

Has dispensed a self-administered hormonal contraceptive under the standingprotocol orderestablished issued pursuant to section 82.5 of this act without complying with section 3 of this act;

for Thisthe subsectionoperation appliesof tothe anfacility.ner owner or other principal responsible forSec. the operation of the facility.

- *SB190_R1* – 7 – Sec.

(d)- Insertion81st orSession removal(2021) – 8 – [(d)] (e) Education and counseling relating to the initiation of athe deviceuse forof contraception;contraceptives and any necessary follow-up after initiating such use;

[(d)] (e) Education and counseling relating to the initiation of the use of contraceptives and any necessary follow-up after initiating such use;

4.higher deductible, copayment or coinsurance for a drug foro pay a contraception if the person refuses to accept a therapeutic equivalent of the contraceptive drug.

The Plan may require a person enrolled in Medicaid to pay a higher deductible, copayment or coinsurance for a drug for contraception if the person refuses to accept a therapeutic equivalent of the contraceptive drug.

- *SB190_R1* – 8 – (b) “Therapeutic equivalent” means a drug which:

(1) Contains an identical amount of the same active ingredientsanother indrug;n the same dosage and method of administration as (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

Chapter(Deleted 439 of NRS is hereby amended by addingamendment.) thereto- a81st newSession section(2021) to– read9 as– follows:Sec.

1.8.5.

TheNRS Chief683A.179 Medicalis Officerhereby oramended his or her designee shall issue a standing order to allowread aas pharmacistfollows: to dispense a self- administered hormonal contraceptive to any patient pursuant to section 3 of this act.

683A.179 1.

A pharmacy benefit manager shall not:

(a) Prohibit a pharmacist or pharmacy from providing informa(1) The amount of any copayment or coinsurance for a prescription drug;

or (2) The availability of a less expensive alternative or generic drug including, without limitation, information concerning clinical efficacy of such a drug;

(b) Penalize a pharmacist or pharmacy for providing the information described in paragraph (a) or selling a less expensive alternative or generic drug to a covered person;

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

or (d) If the pharmacy benefit manager manages a pharmacy benefits plan that provides coverage through a network plan, charge a copayment or coinsurance for a prescription drug in an amount that is greater than the total amount paid to a pharmacy that is in the network of providers under contract with the third party.

InThe consultationprovisions with the Chief Medical Officer, the State Board of Healththis shallsection: prescribe by regulation a protocol for dispensing a self-administered hormonal contraceptive.

The(a) protocolMust mustnot include,be construed to authorize a pharmacist to dispense a drug that has not been prescribed by a practitioner, as defined in NRS 639.0125 [.] , except to the extent authorized by a specific provision of law, including, without limitation:limitation, NRS 453C.120 and section 3 of this act.

(a)639.0085, Requirementsor governinga thepharmacist informationworking that must be included in such a recordpharmacy concerningas theaned dispensing of the self- administered hormonal contraceptive in additionNRS toemployee theor informationindependent requiredcontractor. by section 3 of this act;

and (b) The amount of time that such a record must be maintained by the dispensing pharmacist or his or her employer.

InAs consultationused within this section, “network plan” means a health benefit plan offered by a health carrier under which the Statefinancing Boardand delivery of Pharmacy,medical thecare Stateis Boardprovided, in whole or in part, through a defined set of Healthproviders shallunder adoptcontract regulationswith thatthe prescribe:carrier.

(a)The Aterm riskdoes assessmentnot questionnaireinclude thatan mustarrangement befor providedthe tofinancing a patient who requests a self-administered hormonal contraceptive pursuant to section 3 of thispremiums. act.

(b) The information that must be provided in writing to a patient to whom a self-administered hormonal contraceptive is dispensed pursuant to section 3 of this act, which may include, without limitation, information concerning:

(1) The importance of obtaining recommended tests and screening from the patient’s attending provider or another qualified provider of health care who specializes in women’s health;

(2) The effectiveness of long-acting reversible contraceptives as an alternative to self-administered hormonal contraceptives;

(3) When to seek emergency medical services as a result of administering a self-administered hormonal contraceptive;

and (4) The risk of contracting a sexually transmitted infection and ways to reduce that risk.

- *SB190_R1* – 9 – 4.

The Division shall provide on an Internet website maintained by the Division an electronic link to the list of pharmacies maintained by the State Board of Pharmacy pursuant to section 3 of this act.

5.

As used in this section:

(a) “Attending provider” has the meaning ascribed to it in section 3 of this act.

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

(c) “Self-administered hormonal contraceptive” has the meaning ascribed to it in section 2 of this act.

(2)- Approved81st bySession the(2021) Food– and10 Drug– Administration;(3) Listed in subsection 10;

(3)andg ListedAdministration; in subsection 10;

and (4) Dispensed in accordance with NRS 639.28075;

and [(f)]2.f)]An (g)insurer Voluntarymust sterilizationensure forthat women.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 insurer.

2.

An insurer must 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 insurer.

- *SB190_R1* – 10 – 4.

(b) Refuse to issue a policy of health insurance or cancel a policycovered ofby healththe insurancepolicy solelyuses becauseor themay personuse applyingany such benefit;plying for or covered(c) byOffer theor policypay usesany type of material inducement or mayfinancial useincentive to an insured to discourage the insured from obtaining any such benefit;

(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

- 81st Session (2021) – 11 – (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

or (f) Impose any other restrictions or delays on the access of an ins5.ed Coverage pursuant to this section for the covered dependent of an insured anymust suchbe benefit.the same as for the insured.

5.

Coverage pursuant to this section for the covered dependent of an insured must be the same as for the insured.

For each of the 18 methods of contraception listed in subsection 10 that have been approved by the Food and Drug Administration, a policy of health insurance must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to thethehich insured, but the insurer may charge a deductible, copayment or - *SB190_R1* – 11 – coinsurance for any other drug or device that provides the same method of contraception.

(j)- Estrogen-81st andSession progestin-based(2021) – 12 – (k) Vaginal contraceptive rings;d patches;

(k) Vaginal contraceptive rings;

12.require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care.

An insurer shall not use medical management techniques to require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care.

- *SB190_R1* – 12 – (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.

(1)- Contains81st anSession identical(2021) amount– of13 the– same active ingredients in the same dosage and method of administration as another drug;

(3)(4) ListedDispensed in subsectionaccordance 11;with NRS 639.28075;

and (4) Dispensed in accordance with NRS 639.28075;

and [(f)]2.f)]An (g)insurer Voluntarymust sterilizationensure forthat women.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 insurer.

- *SB190_R1* – 13 – 2.

An insurer must 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 insurer.

- 81st Session (2021) – 14 – 4.

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit included in the policy pursuant to subsection 1;

Except as otherwise provided in subsection 7, a policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2018,] 2022, has the legal effect of including the coverage required by subsection 1, and anythis provisionsection ofis thevoid.policy policy or the renewal which is in conflict with this7. section is void.

7.

- *SB190_R1* – 14 – 8.

- 81st Session (2021) – 15 – 10.

For each of the 18 methods of contraception listed in subsection 11 that have been approved by the Food and Drug Administration, a policy of group health insurance must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

(q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

andandption or progestin-based drugs for emergency (r) Ulipristal acetate for emergency contraception.

- *SB190_R1* – 15 – 14.

An insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the- insurer81st toSession obtain(2021) any– benefit16 required– byhigher deductible, copayment or coinsurance.y this section without a higher15. deductible, copayment or coinsurance.

15.

(1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

(2) Approved by the Food and Drug Administration;

andandg (4)Administration; Dispensed in accordance with NRS 639.28075;

(4) Dispensed in accordance with NRS 639.28075;

- *SB190_R1* – 16 – (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to section 3 of this act;

- 81st Session (2021) – 17 – (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same health benefit plan;

[(d)] (e) Education and counseling relating to the initiation of thesuch useuse;f of contraception and any necessary follow-up after initiating such[(e)] use;(f) Management of side effects relating to contraception;

[(e)] (f) Management of side effects relating to contraception;

(c) Offer or pay any type of material inducement or financial incentivesuch tobenefit;an an insured to discourage the insured from obtaining any (d) Penalize a provider of health care who provides any such benefit;benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

(d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

Except as otherwise provided in subsection 7, a health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2018,] 2022, has the legal effect of including the coverage required - *SB190_R1*81st Session (2021) – 1718 – by subsection 1, and any provision of the plan or the renewal which is in conflict with this section is void.

A carrier that offers or issues a health benefit plan and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the carrier objects on religious grounds.

(f) Injections;

11.- 81st Session (2021) – 19 – law, a carrier may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

Except as otherwise provided in this section and federal law, a carrier may use medical management techniques, including, without limitation, any available clinical evidence, to determine the - *SB190_R1* – 18 – frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

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

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

Except as otherwise provided in subsection 7, a society that offers or issues a benefit contract which provides coverage- for81st prescriptionSession (2021) – 20 – contract coverage for:ion drugs or devices shall include in the contract(a) coverageUp for:to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

(a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

- *SB190_R1* – 19 – (3) Listed in subsection 10;

[(d)] (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for any benefit included in the benefit contract pursuant to subsection 1;

- 81st Session (2021) – 21 – (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

- *SB190_R1* – 20 – 5.

For each of the 18 methods of contraception listed in subsection 10 that have been approved by the Food and Drug Administration, a benefit contract must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the society may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

- 81st Session (2021) – 22 – (h) Progestin-based drugs;

(l)(m) DiaphragmsSponges with spermicide;spermicide;de;

(m) Sponges with spermicide;

- *SB190_R1* – 21 – (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

A society must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the society to obtain any benefit required by this section without a higherhig14. deductible, copayment or coinsurance.

14.

coinsurance.

(1)- Contains81st anSession identical(2021) amount– of23 the– same active ingredients in the same dosage and method of administration as another drug;

- *SB190_R1* – 22 – Sec.

(3)(4) ListedDispensed in subsectionaccordance 11;with NRS 639.28075;

and (4) Dispensed in accordance with NRS 639.28075;

and [(f)]2.f)]An (g)insurer Voluntarythat sterilizationoffers or issues a contract for women.hospital or medical services must 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 insurer.

2.

An insurer that offers or issues a contract for hospital or medical services must 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 insurer.

4.- 81st Session (2021) – 24 – insurer that offers or issues a contract for hospital or medical service shall not:

Except as otherwise provided in subsections 9, 10 and 12, an insurer that offers or issues a contract for hospital or medical service shall not:

(b) Refuse to issue a contract for hospital or medical service or cancel a contract for hospital or medical service solely because the - *SB190_R1* – 23 – person applying for or covered by the contract uses or may use any such benefit;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce,reduce,er withhold, limit or delay access to any such benefit to an insured;

An insurer that offers or issues a contract for hospital or medical service and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if before the issuance of a contract for hospital or medical service and before the renewal of such a contract, provide to the prospective insured written notice of the coverage that the insurer objectsrefuses onto religiousprovide grounds.pursuant to this subsection.

Such an insurer shall, before the issuance of a contract for hospital or medical service and before the renewal of such a contract, provide to the prospective insured written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

- 81st Session (2021) – 25 – 9.

For each of the 18 methods of contraception listed in subsection 11 that have been approved by the Food and Drug Administration, a contract for hospital or medical service must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

- *SB190_R1* – 24 – (a) Voluntary sterilization for women;

(o)(p) FemaleSpermicide;oms; condoms;

(p) Spermicide;

14.- 81st Session (2021) – 26 – expedited process which is not unduly burdensome by which and insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

An insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

(b) “Network plan” means a contract for hospital or medical service offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical - *SB190_R1* – 25 – care, are provided, in whole or in part, through a defined set of providers under contract with the insurer.

The term does not include an arrangement(c) for“Provider of health care” has the financingmeaning ofascribed premiums.to it in NRS 629.031.

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

Except as otherwise provided in subsection 7, a health maintenance organization that offers or issues a health care planpla(a) shallUp includeto ina the12-month plansupply, coverageper for:prescription, of any type of drug for contraception or its therapeutic equivalent which is:

(a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

and (3)- Listed81st inSession subsection(2021) 11;– 27 – (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to section 3 of this act;

(c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to section 3 of this act;

- *SB190_R1* – 26 – 3.

If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the health maintenance organization.

(c) Offer or pay any type of material inducement or financial incentive to an enrollee to discourage the enrollee from obtaining any(d) Penalize a provider of health care who provides any such benefit;benefit to an enrollee, including, without limitation, reducing the reimbursement of the provider of health care;

(d) Penalize a provider of health care who provides any such benefit to an enrollee, including, without limitation, reducing the reimbursement of the provider of health care;

- 81st Session (2021) – 28 – 5.

Except as otherwise provided in subsection 7, a health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2018,] 2022, has the legal effect of including the coverage required by subsection 1, and any provision of the plan or the renewal which is in conflict with this section is void.

If a health maintenance organization refuses, pursuant to subsection 7, to provide the coverage required by subsection 1, an - *SB190_R1* – 27 – employer may otherwise provide for the coverage for the employees of the employer.

For each of the 18 methods of contraception listed in subsection 11 that have been approved by the Food and Drug Administration, a health care plan must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the enrollee, but the health maintenance organization may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

- 81st Session (2021) – 29 – (j) Estrogen- and progestin-based patches;

(n)(o) CervicalFemale capscondoms;ith with spermicide;

(o) Female condoms;

A health maintenance organization shall not use medical management techniques to require an enrollee to use a method of - *SB190_R1* – 28 – contraception other than the method prescribed or ordered by a provider of health care.

A health maintenance organization must provide an accessible, transparent and expedited process which is not unduly burdensome by which an enrollee, or the authorized representative of the enrollee, may request an exception relating to any medical management technique used by the health maintenance organization to obtain any benefit required by this section without a higher deductible,ded15. copayment or coinsurance.

15.As used in this section:rance.

As used in this section:

(1)- Contains81st anSession identical(2021) amount– of30 the– same active ingredients in the same dosage and method of administration as another drug;

(3)(4) ListedDispensed in subsectionaccordance 10;with NRS 639.28075;

and (4) Dispensed in accordance with NRS 639.28075;

- *SB190_R1* – 29 – (2) Approved by the Food and Drug Administration;

and [(f)]2.f)]A (g)managed Voluntarycare sterilizationorganization formust women.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 managed care organization.

2.

A managed care organization must 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 managed care organization.

- 81st Session (2021) – 31 – 4.

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit included in the health care plan pursuant to subsection 1;

- *SB190_R1* – 30 – 6.

Except as otherwise provided in subsection 7, a health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2018,] 2022, has the legal effect of including the coverage required by subsection 1, and anythis provisionsection ofis thevoid.plan plan or the renewal which is in conflict with this7. section is void.

7.

For each of the 18 methods of contraception listed in subsection 10 that have been approved by the Food and Drug - 81st Session (2021) – 32 – Administration, a health care plan must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the managed care organization may charge a deductible, copaymentthe orsame coinsurancemethod forof anycontraception.other other drug or device that provides the10. same method of contraception.

10.

- *SB190_R1* – 31 – (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

and (r)11. Ulipristal acetate for emergency contraception.

11.

A managed care organization must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the managed care organization to obtain any - 81st Session (2021) – 33 – benefit required by this section without a higher deductible, copayment or coinsurance.

(b) “Network plan” means a health care plan offered by a managed care 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 managed care organization.

TheThef term does not include an arrangement for the financing of premiums.

- *SB190_R1* – 32 – Sec.

(a) Upon passage and approval for the purposes of adopting any regulations and performing any other preparatory administrative tas(b)tasks Onthat Januaryare 1,necessary 2022,to forcarry allout otherthe purposes.nsprovisions of this act;

and H(b) -On *SB190_R1*January 1, 2022, for all other purposes.

~~~~~ 21 - 81st Session (2021)