SB 290 — Enacts provisions relating to prescription drugs for the treatment of cancer. (BDR 57-973)

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 ruling - *SB290_R1* – 5 – require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and section 1 of this act.

Sec.thereto a new section to read as follows:y amended by adding 1.

3.An insurer that offers or issues a policy of group health insurance which provides coverage of a prescription drug for the treatment of cancer or any symptom of cancer that is part of a step therapy protocol shall allow an insured who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the insured to apply for an exemption from the step therapy protocol.

Chapter 689B of NRS is hereby amended by adding thereto a new section to read as follows:

1.

Except as otherwise provided in subsection 9, an insurer that offers or issues a policy of group health insurance which provides coverage of a prescription drug for the treatment of cancer or any symptom of cancer that is part of a step therapy protocol shall allow an insured who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the insured to apply for an exemption from the step therapy protocol.

(b) Clearly prescribe the information and supporting documentation that must be submitted with the application, the criteria that will be used to evaluate the request and the conditions - 81st Session (2021) – 5 – under which an expedited determination pursuant to subsection 4 is warranted.

2.pursuant to paragraph (b) of subsection 1:mentation required (a) May include, without limitation:

The information and supporting documentation required pursuant to paragraph (b) of subsection 1:

(a) May include, without limitation:

and - *SB290_R1* – 6 – (b) If it requests additional information or documentation, make a determination concerning the application not later than 72 hours after receiving the requested information or documentation.

An insurer shall disclose to the insured or attending practitioner who submits an application for an exemption from a step therapy protocol pursuant to subsection 1 the name and qualifications of each person who will review the application.

(a)- Any81st treatmentSession otherwise(2021) required– under6 the– step therapy or any drug in the same pharmacological class or having the samesamey or mechanism of action as the drug for which the exemption is requested has not been effective at treating the cancer or symptom of the insured when prescribed in accordance with clinical indications, clinical guidelines or other peer-reviewed evidence;

or (2) Has prevented or is likely to prevent the insured from performing the responsibilities of his or her occupation or engaging in activities of daily living, as defined in 42 C.F.R.

If an insurer approves an application for an exemption from a step therapy protocol pursuant to this section, the insurer must cover the prescription drug to which the exemption applies in - *SB290_R1* – 7 – accordance with the terms of the applicable policy of group health insurance.

If the attending practitioner determines after 1 week that the drug is effective at treating the cancer or symptom for which it was prescribed, the insurer must continue to cover the drug for as long as it is necessary to treat the insured for the cancer or symptom.

- 81st Session (2021) – 7 – 8.

IfA a policy of group health insurance usessubject ato formulary, the insurerrenewed ison notor requiredafter toJanuary allow1, an2022, insuredhas tothe applylegal foreffect anofivery exemptionor fromincluding athe stepcoverage therapyrequired protocolby pursuantthis tosection, thisand sectionany forprovision aof drugthe policy that isconflicts notwith includedthis insection theis formulary.void.

A policy of group 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 this section, and any provision of the policy that conflicts with this section is void.

11.

ExceptA as otherwise provided in subsection 9, a carrier that offers or issues a health benefit plan which provides coverage of a prescription drug for the treatment of cancer or any symptom of cancer that is part of a step therapy protocol shall allow an insured who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the insured to apply for an exemption from the step therapy protocol.

(b) Clearly prescribe the information and supporting documentation that must be submitted with the application, the criteria that will be used to evaluate the request and the conditions - *SB290_R1* – 8 – under which an expedited determination pursuant to subsection 44itions is warranted.

and - 81st Session (2021) – 8 – (2) Any other relevant clinical information.

3.receives an application for an exemption pursuant to subsection 1at shall:

Except as otherwise provided in subsection 4, a carrier that receives an application for an exemption pursuant to subsection 1 shall:

A carrier shall disclose to the insured or attending practitioner who submits an application for an exemption from a step therapy protocol pursuant to subsection 1 the name and qualifications of each person who will review the application.

(a) Any treatment otherwise required under the step therapy or any drug in the same pharmacological class or having the samesamey or mechanism of action as the drug for which the exemption is - *SB290_R1* – 9 – requested has not been effective at treating the cancer or symptom of the insured when prescribed in accordance with clinical indications, clinical guidelines or other peer-reviewed evidence;

or - 81st Session (2021) – 9 – (2) Has prevented or is likely to prevent the insured from performing the responsibilities of his or her occupation or engaging in activities of daily living, as defined in 42 C.F.R.

(d) The condition of the insured is stable while being treated with the prescription drug for which the exemption is requestedrequesteded and the insured has previously received approval for coverage of that drug;

A carrier shall post in an easily accessible location on an Internet website maintained by the carrier a form for requesting an exemption9.emA pursuanthealth benefit plan subject to the provisions of this section.chapter that is delivered, issued for delivery or renewed on or after January 1, 2022, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void.

9.10.

If a health benefit plan uses a formulary, the carrier is not required to allow an insured to apply for an exemption from a step therapy protocol pursuant to this section for a drug that is not included in the formulary.

- *SB290_R1* – 10 – 10.

A health benefit 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 this section, and any provision of the policy that conflicts with this section is void.

11.

689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, and section 4 of this act to the extent - 81st Session (2021) – 10 – applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive.

1.provides coverage of a prescription drug for the treatment ofch cancer or any symptom of cancer that is part of a step therapy protocol shall allow an insured who has been diagnosed with stage or 4 cancer or the attending practitioner of the insured to apply for an exemption from the step therapy protocol.

Except as otherwise provided in subsection 9, a society that offers or issues a benefit contract which provides coverage of a prescription drug for the treatment of cancer or any symptom of cancer that is part of a step therapy protocol shall allow an insured who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the insured to apply for an exemption from the step therapy protocol.

(I) Tried other drugs included in the pharmacological class of drugs for which the exemption is requested withoutwithoutcal success;

or - *SB290_R1* – 11 – (II) Taken the requested drug for a clinically appropriate amount of time to establish stability in relation to the cancer and the guidelines of the prescribing practitioner;

(a) Make a determination concerning the application if the application is complete or request additional information or documentation- necessary81st toSession complete(2021) the– application11 not– later than 72 hours after receiving the application;

andandn not later (b) If it requests additional information or documentation, make a determination concerning the application not later than 72 hours after receiving the requested information or documentation.

A society shall disclose to the insured or attending practitioner who submits an application for an exemption from a step therapy protocol pursuant to subsection 1 the name and qualifications of each person who will review the application.

A society must grant an exemption from a step therapy protocol in response to an application submitted pursuant to subsectionsub(a) 1Any if:treatment otherwise required under the step therapy or any drug in the same pharmacological class or having the same mechanism of action as the drug for which the exemption is requested has not been effective at treating the cancer or symptom of the insured when prescribed in accordance with clinical indications, clinical guidelines or other peer-reviewed evidence;

(a) Any treatment otherwise required under the step therapy or any drug in the same pharmacological class or having the same mechanism of action as the drug for which the exemption is requested has not been effective at treating the cancer or symptom of the insured when prescribed in accordance with clinical indications, clinical guidelines or other peer-reviewed evidence;

- *SB290_R1* – 12 – (1) Is contraindicated for the insured or has caused or is likely, based on peer-reviewed clinical evidence, to cause an adverseadvers(2) reactionHas prevented or otheris physicallikely harm to prevent the insured;insured from performing the responsibilities of his or her occupation or engaging in activities of daily living, as defined in 42 C.F.R.

or (2) Has prevented or is likely to prevent the insured from performing the responsibilities of his or her occupation or engaging in activities of daily living, as defined in 42 C.F.R.

or - 81st Session (2021) – 12 – (e) Any other condition for which such an exemption is required by regulation of the Commissioner is met.

If a society approves an application for an exemption from a step therapy protocol pursuant to this section, the society must cover the prescription drug to which the exemption applies in accordance with the terms of the applicable benefit contract.

IfA a benefit contract usessubject ato formulary, the societyprovisions of this chapter that is notdelivered, requiredissued tofor allowdelivery anor insuredrenewed toon applyor forafter anJanuary exemption1, from2022, ahas stepthe therapylegal protocoleffect pursuantof toincluding the coverage required by this sectionsection, forand aany drugprovision of the benefit contract that isconflicts notwith includedthis insection theis formulary.void.

AAs benefitused contractin subject to the provisions of this chaptersection, that“attending ispractitioner” delivered,means issuedthe forpractitioner, deliveryas ordefined renewedin onNRS or639.0125, afterwho Octoberhas 1,primary 2021,such hascancer theof legalan effectinsured.atment of including the coveragecancer requiredor by this section, and any provisionsymptom of theSec. benefit contract that conflicts with this section is void.

11.

As used in this section, “attending practitioner” means the practitioner, as defined in NRS 639.0125, who has primary responsibility for the treatment of the cancer or any symptom of such cancer of an insured.

- *SB290_R1* – 13 – Sec.

ExceptA as otherwise provided in subsection 9, a hospital or medical services corporation that offers or issues a policy of health insurance which provides coverage of a prescription drug for the treatment of cancer or any symptom of cancer that is part of a step therapy protocol shall allow an insured who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the insured to apply for an exemption from the step therapy protocol.

- 81st Session (2021) – 13 – (b) Clearly prescribe the information and supporting documentation that must be submitted with the application, the criteria that will be used to evaluate the request and the conditions under which an expedited determination pursuant to subsection 4 is warranted.(c) Require the review of each application by at least one physician, registered nurse or pharmacist.

(c) Require the review of each application by at least one physician, registered nurse or pharmacist.

(a) Make a determination concerning the application if the application is complete or request additional information or documentation necessary to complete the application not later than 72 hours after receiving the application;

andandn -not *SB290_R1*later – 14 – (b) If it requests additional information or documentation, make a determination concerning the application not later than 72 hours after receiving the requested information or documentation.

A hospital or medical services corporation shall disclose to the insured or attending practitioner who submits an application for an exemption from a step therapy protocol pursuant to subsection- 181st theSession name(2021) and– qualifications14 of– each person who will review the application.

the qualifications of each person who will review the 6.

(c)(c)(1) EachIs treatmentcontraindicated otherwisefor requiredthe underinsured theor stephas therapy:caused or is likely, based on peer-reviewed clinical evidence, to cause an adverse reaction or other physical harm to the insured;

(1) Is contraindicated for the insured or has caused or is likely, based on peer-reviewed clinical evidence, to cause an adverse reaction or other physical harm to the insured;

- *SB290_R1* – 15 – 7.

If a hospital or medical services corporation approves an application for an exemption from a step therapy protocol pursuant to this section, the hospital or medical services corporation must cover the prescription drug to which thethes exemption applies in accordance with the terms of the applicable policy of health insurance.

If the attending practitioner determines after 1 week that the drug is effective at treating the cancer or symptom for which it was prescribed, the hospital or medical services corporation must continue to cover the drug for as long as it is necessary to treat the insured for the - 81st Session (2021) – 15 – cancer or symptom.

The hospital or medical services corporation may conduct a review not more frequently than once each quarter to determine, in accordance with available medical evidence, whether the drug remains necessary to treat the insured for the cancershall orprovide symptom.a report of the review to the insured.corporation 8.

The hospital or medical services corporation shall provide a report of the review to the insured.

8.

IfA a policy of health insurance usessubject ato formulary, the hospitalprovisions orof medicalthis serviceschapter corporationthat is notdelivered, requiredissued tofor allowdelivery anor insuredrenewed toon applyor forafter anJanuary exemption1, from2022, ahas stepthe therapylegal protocoleffect pursuantof toincluding the coverage required by this sectionsection, forand aany drugprovision of the policy that isconflicts notwith includedthis insection theis formulary.void.

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 this section, and any provision of the policy that conflicts with this section is void.

11.

ExceptA as otherwise provided in subsection 9, a health maintenance organization that offers or issues a health care plan which provides coverage of a prescription drug for the treatment of cancer or any symptom of cancer that is part of a step therapy protocol shall allow an enrollee who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the enrollee to - *SB290_R1* – 16 – apply for an exemption from the step therapy protocol.pro(a) Allow the enrollee or attending practitioner, or aust:

Thedesignated applicationadvocate process for suchthe anenrollee or attending practitioner, to present to the health maintenance organization the clinical rationale for the exemption must:and any relevant medical information.

(a) Allow the enrollee or attending practitioner, or a designated advocate for the enrollee or attending practitioner, to present to the health maintenance organization the clinical rationale for the exemption and any relevant medical information.

- 81st Session (2021) – 16 – (1) The medical history or other health records of the enrollee demonstrating that the enrollee has:

or (II) Taken the requested drug for a clinically appropriate amount of time to establish stability in relation to the cancer and the guidelines of the prescribing practitioner;

If, in the opinion of the attending practitioner, a step therapy protocol may seriously jeopardize the life or health of the enrollee, a health maintenance organization that receives an application for an exemption pursuant to subsection 1 must make a determination concerning the application as expeditiously as necessary to avoid serious jeopardy to the life or health of the enrollee.

-to *SB290_R1*avoid –serious 17jeopardy –to the life or health of the 5.

A health maintenance organization shall disclose to the enrollee or attending practitioner who submits an application for an exemption from a step therapy protocol pursuant to subsection 1 the name and qualifications of each person who will review the application.

(b)- Delay81st ofSession effective(2021) treatment– would17 have– severe or irreversible consequences for the enrollee and the treatment otherwise required under the step therapy is not reasonably expected to be effective based on the physical or mental characteristics of the enrollee and the known characteristics of the treatment;

(d) The condition of the enrollee is stable while being treated with the prescription drug for which the exemption is requested and the enrollee has previously received approval for coverage of thattha(e) drug;Any other condition for which such an exemption is required by regulation of the Commissioner is met.

or (e) Any other condition for which such an exemption is required by regulation of the Commissioner is met.

If the attending practitioner determines after 1 week that the drug is effective at treating the cancer or symptom for which it was prescribed, the health maintenance organization must continue to cover the drug for as long as it is necessary to treat the enrollee for - *SB290_R1* – 18 – the cancer or symptom.

The health maintenance organization may conduct a review not more frequently than once each quarter to determine, in accordance with available medical evidence, whether the drug remains necessary to treat the enrollee for the cancer or symptom.

IfA a health care plan usessubject ato formulary, the healthprovisions maintenanceof organizationthis chapter that is notdelivered, requiredissued tofor allowdelivery anor enrolleerenewed toon applyor forafter an- exemption81st fromSession a(2021) step– therapy18 protocol– pursuantJanuary to1, 2022, has the legal effect of including the coverage required by this sectionsection, forand aany drugprovision of the health care plan that isconflicts notwith includedthis insection theis formulary.void.

AAs healthused carein plan subject to the provisions of this chaptersection, that“attending ispractitioner” delivered,means issuedresponsibility for delivery or renewed on or after October 1, 2021, has the legaltreatment effect of including the coveragecancer requiredor by this section, and any provisionsymptom of thesuch healthcancer careof planan thatenrollee. conflicts with this section is void.

11.

As used in this section, “attending practitioner” means the practitioner, as defined in NRS 639.0125, who has primary responsibility for the treatment of the cancer or any symptom of such cancer of an enrollee.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 695C.265 and section 8 of this act 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 - *SB290_R1* – 19 – Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services.

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 8 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 Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization - 81st Session (2021) – 19 – pursuant to the provisions of this chapter if the Commissioner finds that any of the following conditions exist:

(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant and to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

(f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to participate in matters relating to the content of programs pursuant to NRS(g) The health maintenance organization has failed to put into effect the system required by NRS 695C.110;695C.260 for:

(g)(1) TheResolving healthcomplaints maintenancein organizationa hasmanner failedreasonably to putdispose intoof effectvalid thecomplaints; system required by NRS 695C.260 for:

- *SB290_R1* – 20 – (1) Resolving complaints in a manner reasonably to dispose of valid complaints;

or - 81st Session (2021) – 20 – (k) The health maintenance organization has otherwise failed to comply substantially with the provisions of this chapter.

3.organization is suspended, the health maintenance organization shall not, during the period of that suspension, enroll any additional groups or new individual contracts, unless those groups or persons were contracted for before the date of suspension.

If the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of that suspension, enroll any additional groups or new individual contracts, unless those groups or persons were contracted for before the date of suspension.

ExceptA as otherwise provided in subsection 9, a managed care organization that offers or issues a health care plan which provides coverage of a prescription drug for the treatment of cancer or any symptom of cancer that is part of a step therapy protocol shall allow an insured who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the insuredThe toapplication applyprocess for such an exemption frommust:rapy the step therapy protocol.

The(a) applicationAllow processthe insured or attending practitioner, or a designated advocate for suchthe aninsured or attending practitioner, to present to the managed care organization the clinical rationale for the exemption must:and any relevant medical information.

(a) Allow the insured or attending practitioner, or a designated advocate for the insured or attending practitioner, to present to the - *SB290_R1* – 21 – managed care organization the clinical rationale for the exemption and any relevant medical information.

- 81st Session (2021) – 21 – (1) The medical history or other health records of the insured demonstrating that the insured has:

or (II) Taken the requested drug for a clinically appropriate amount of time to establish stability in relation to the cancer and the guidelines of the prescribing practitioner;

If, in the opinion of the attending practitioner, a step therapy protocol may seriously jeopardize the life or health of the insured, a managed care organization that receives an application for an exemption pursuant to subsection 1 must make a determination concerning the application as expeditiously as necessaryinsured.y to avoid serious jeopardy to the life or health of the insured.5.

5.A managed care organization shall disclose to the insured or attending practitioner who submits an application for an exemption from a step therapy protocol pursuant to subsection 1 the qualifications of each person who will review the application.

A managed care organization shall disclose to the insured or attending practitioner who submits an application for an exemption from a step therapy protocol pursuant to subsection 1 - *SB290_R1* – 22 – the name and qualifications of each person who will review the application.

(b)- Delay81st ofSession effective(2021) treatment– would22 have– severe or irreversible consequences for the insured and the treatment otherwise required under the step therapy is not reasonably expected to be effective based on the physical or mental characteristics of the insured and the known characteristics of the treatment;

(d) The condition of the insured is stable while being treated with the prescription drug for which the exemption is requested and the insured has previously received approval for coverage of thattha(e) drug;Any other condition for which such an exemption is required by regulation of the Commissioner is met.

or (e) Any other condition for which such an exemption is required by regulation of the Commissioner is met.

The managed care organization may conduct a review not more frequently than once each quarter to determine, in accordance with available medical evidence, whether the drug - *SB290_R1* – 23 – remains necessary to treat the insured for the cancer or symptom.

IfA a health care plan usessubject ato formulary, the managedprovisions careof organizationthis chapter that is notdelivered, requiredissued tofor allowdelivery anor insuredrenewed toon applyor forafter an- exemption81st fromSession a(2021) step– therapy23 protocol– pursuantJanuary to1, 2022, has the legal effect of including the coverage required by this sectionsection, forand aany drugprovision of the health care plan that isconflicts notwith includedthis insection theis formulary.void.

AAs healthused carein plan subject to the provisions of this chaptersection, that“attending ispractitioner” delivered,means issuedresponsibility for delivery or renewed on or after October 1, 2021, has the legaltreatment effect of including the coveragecancer requiredor by this section, and any provisionsymptom of thesuch healthcancer careof planan thatinsured. conflicts with this section is void.

11.

As used in this section, “attending practitioner” means the practitioner, as defined in NRS 639.0125, who has primary responsibility for the treatment of the cancer or any symptom of such cancer of an insured.

NRS(Deleted 695G.090by isamendment.) herebySec. amended to read as follows:

695G.090 1.

Except as otherwise provided in subsection 3, the provisions of this chapter apply to each organization and insurer that operates as a managed care organization and may include, without limitation, an insurer that issues a policy of health insurance, an insurer that issues a policy of individual or group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical service corporation and a health maintenance organization.

2.

In addition to the provisions of this chapter, each managed care organization shall comply with:

(a) The provisions of chapter 686A of NRS, including all obligations and remedies set forth therein;

and (b) Any other applicable provision of this title.

3.

The provisions of NRS 695G.164, 695G.1645, 695G.167, 695G.200 to 695G.230, inclusive, and 695G.430 and section 11 of this act do not apply to a managed care organization that provides health care services 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 the Division of Health Care Financing and Policy of the Department of Health and Human Services.

This subsection does not exempt a managed care organization from any provision of this chapter for services provided pursuant to any other contract.

- *SB290_R1* – 24 – Sec.

(b) Purchase group policies of life, accident or health insurance, or any combination thereof, for the benefit of such officers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the business of such insurance in the State of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions uponupo(c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the premiums.maintenance of the fund from the compensation of officers and employees and pay the deductions into the fund.

(c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the maintenance of the fund from the compensation of officers and employees and pay the deductions into the fund.

Any contract with an independent administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits- provided.81st Session (2021) – 24 – 689B.050, inclusive, and section 3 of this act, 689B.287 andto 689B.500 apply to coverage provided pursuant to this paragraph, except that the provisions of NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage for active officers and employees of the governing body, or the dependents of such officers and employees.

The provisions of NRS 687B.408, 689B.030 to 689B.050, inclusive, and section 3 of this act, 689B.287 and 689B.500 apply to coverage provided pursuant to this paragraph, except that the provisions of NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage for active officers and employees of the governing body, or the dependents of such officers and employees.

The money for contributions must be budgeted for in accordance with the laws - *SB290_R1* – 25 – governing the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada.

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.

(a) Shall be deemed, solely for the purposes of this section, to be officers and employees of the county, school district, municipal to be corporation, political subdivision, public corporation or other local governmental agency with which the legal services organization has contracted;

- 81st Session (2021) – 25 – (a) Must be submitted to the Commissioner of Insurance for approval not less than 30 days before the date on which the contract is to become effective.

(b) Does not become effective unless approved by the Commissioner.Com(c) Shall be deemed to be approved if not disapproved by the Commissioner within 30 days after its submission.

(c) Shall be deemed to be approved if not disapproved by the Commissioner within 30 days after its submission.

- *SB290_R1* – 26 – follows:13.

NRS 287.04335 is hereby amended to read as 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, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.170 to 695G.174, inclusive, and section 11 of this act, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

13.

NRS 287.04335 is hereby amended to read as follows:

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, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.170 to 695G.174, inclusive, and section 11 of this act, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

Sec.

14.5.

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

1.

The Department or a pharmacy benefit manager or health maintenance organization with which the Department contracts pursuant to NRS 422.4053 to manage prescription drug benefits stage 3 or 4 cancer or the attending practitioner of the recipient to apply for an exemption from step therapy that would otherwise be required pursuant to NRS 422.403 to instead use a prescription drug prescribed by the attending practitioner to treat the cancer or any symptom thereof of the recipient of Medicaid.

The application process must:

(a) Allow the recipient or attending practitioner, or a designated advocate for the recipient or attending practitioner, to present to the Department, pharmacy benefit manager or health maintenance organization, as applicable, the clinical rationale for the exemption and any relevant medical information.

(b) Clearly prescribe the information and supporting documents that must be submitted with the application, the criteria that will be used to evaluate the request and the conditions under - 81st Session (2021) – 26 – which an expedited determination pursuant to subsection 4 is warranted.

(c) Require the review of each application by at least one physician, registered nurse or pharmacist.

pursuant to paragraph (b) of subsection 1:mentation required (a) May include, without limitation:

(1) The medical history or other health records of the recipient demonstrating that the recipient has:

(I) Tried other drugs included in the pharmacological class of drugs for which the exemption is requested without success;

or (II) Taken the requested drug for a clinically appropriate amount of time to establish stability in relation to the cancer and the guidelines of the prescribing practitioner;

and (2) Any other relevant clinical information.

(b) Must not include any information or supporting documentation that is not necessary to make a determination about the application.

3.

Except as otherwise provided in subsection 4, the Department, pharmacy benefit manager or health maintenance organization, as applicable, that receives an application for an exemption pursuant to subsection 1 shall:

(a) Make a determination concerning the application if the application is complete or request additional information or documentation necessary to complete the application not later than 72 hours after receiving the application;

and make a determination concerning the application not later than 72 hours after receiving the requested information or documentation.

4.

If, in the opinion of the attending practitioner, step therapy may seriously jeopardize the life or health of the recipient, the Department, pharmacy benefit manager or health maintenance organization that receives an application for an exemption pursuant to subsection 1, as applicable, must make a determination concerning the application as expeditiously as necessary to avoid serious jeopardy to the life or health of the recipient.

5.

The Department, pharmacy benefit manager or health maintenance organization, as applicable, shall disclose to a recipient or attending practitioner who submits an application for an exemption from step therapy pursuant to subsection 1 the qualifications of each person who will review the application.

- 81st Session (2021) – 27 – maintenance organization, as applicable, must grant an exemption from step therapy in response to an application submitted pursuant to subsection 1 if:

(a) Any treatment otherwise required under the step therapy or any drug in the same pharmacological class or having the same mechanism of action as the drug for which the exemption is requested has not been effective at treating the cancer or symptom of the recipient when prescribed in accordance with clinical indications, clinical guidelines or other peer-reviewed evidence;

(b) Delay of effective treatment would have severe or irreversible consequences for the recipient and the treatment otherwise required under the step therapy is not reasonably expected to be effective based on the physical or mental characteristics of the recipient and the known characteristics of the treatment;

(c) Each treatment otherwise required under the step therapy:

likely, based on peer-reviewed clinical evidence, to cause anor is adverse reaction or other physical harm to the recipient;

or (2) Has prevented or is likely to prevent the recipient from performing the responsibilities of his or her occupation or engaging in activities of daily living, as defined in 42 C.F.R.

§ 441.505;

or (d) The condition of the recipient is stable while being treated with the prescription drug for which the exemption is requested and the recipient has previously received approval for coverage of that drug.

7.

If the Department, pharmacy benefit manager or health maintenance organization, as applicable, approves an application for an exemption from step therapy pursuant to this section, the State must pay the nonfederal share of the cost of the prescription drug to which the exemption applies.

The Department, pharmacy limit the coverage to a 1-week supply of the drug for which they exemption is granted.

If the attending practitioner determines after 1 week that the drug is effective at treating the cancer or symptom for which it was prescribed, the State must continue to pay the nonfederal share of the cost of the drug for as long as it is necessary to treat the recipient for the cancer or symptom.

The Department, pharmacy benefit manager or health maintenance organization, as applicable, may conduct a review not more frequently than once each quarter to determine, in accordance - 81st Session (2021) – 28 – with available medical evidence, whether the drug remains necessary to treat the recipient for the cancer or symptom.

The Department, pharmacy benefit manager or health maintenance organization, as applicable, shall provide a report of the review to the8.ecThe Department and any pharmacy benefit manager or health maintenance organization with which the Department contracts pursuant to NRS 422.4053 to manage prescription drug benefits shall post in an easily accessible location on an Internet website maintained by the Department, pharmacy benefit manager or health maintenance organization, as applicable, a form for requesting an exemption pursuant to this section.

9.

As used in this section, “attending practitioner” means the practitioner, as defined in NRS 639.0125, who has primary responsibility for the treatment of the cancer or any symptom of such cancer of a recipient.

Sec.

15.3.

NRS 422.401 is hereby amended to read as follows:

422.401 As used in NRS 422.401 to 422.406, inclusive, and section 14.5 of this act, unless the context otherwise requires, the words and terms defined in NRS 422.4015 to 422.4024, inclusive, have the meanings ascribed to them in those sections.

Sec.

15.6.

NRS 422.406 is hereby amended to read as follows:

422.406 1.

The Department may, to carry out its duties set forth in NRS 422.27172 to 422.27178, inclusive, and 422.401 to 422.406, inclusive, and section 14.5 of this act and to administer the provisions of those sections:

(b) Enter into contracts for any services.

2.

Any regulations adopted by the Department pursuant to NRS 422.27172 to 422.27178, inclusive, and 422.401 to 422.406, inclusive, and section 14.5 of this act must be adopted in accordance with the provisions of chapter 241 of NRS.

Sec.

16.3.

1.

There is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services to pay the increased costs for prescription drugs associated with complying with the provisions of this act the following sums:

For the Fiscal Year 2021-2022..................................$765,814 For the Fiscal Year 2022-2023..................................$753,976 2.

Any balance of the sums appropriated by subsection 1 remaining at the end of the respective fiscal years must not be - 81st Session (2021) – 29 – committed for expenditure after June 30 of the respective fiscal years by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 16, 2022, and September 15, 2023, respectively, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 16, 2022, and September 15, 2023, respectively.

Sec.

16.8.

1.

There is hereby appropriated from the State Public Employees’ Benefits Program the sum of $713,000 to payto the the increased costs for prescription drugs associated with complying with the provisions of this act.

Money appropriated pursuant to this section is available for Fiscal Year 2022-2023 and may be allocated by the Interim Finance Committee to the Public Employees’ Benefits Program upon the presentation to the Interim Finance Committee of an itemization of costs.

2.

Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, 2023, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 15, 2023, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 15, 2023.

Sec.

HSec. - *SB290_R1*

18.

1.

This section and section 16.3 of this act become effective on July 1, 2021.

2.

Sections 1 to 16, inclusive, and 17 of this act become effective on January 1, 2022.

3.

Section 16.8 of this act becomes effective on July 1, 2022.

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