SB 177 — Imposes requirements governing Medicaid coverage of certain antipsychotic or anticonvulsant drugs. (BDR 38-82)

S.B.Senate Bill No.

177177–Senators SDondero ENATELoop, BILLSpearman; N O.

177–SCannizzaro, ENATORSFlores, DONDEROLange, LNeal, OOPNguyen, ,Ohrenschall SPEARMANand ;Pazina Joint Sponsor:

CANNIZZAROAssemblywoman ,Thomas FLORESCHAPTER.......... , LANGE , N EAL , NGUYEN , OHRENSCHALL AND PAZINA FEBRUARY 20, 2023 ____________ JOINT SPONSOR :

ASSEMBLYWOMAN THOMAS ____________ Referred to Committee on Health and Human Services SUMMARY—Imposes requirements governing Medicaid coverage of certain antipsychotic or anticonvulsant drugs.

(BDR 38-82) FISCAL NOTE:

Effect on Local Government:

No.

Effect on the State:

Yes.

~ EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

LegislativeLegExisting Counsel’slaw Digest:requires the Department of Health and Human Services to develop a list of preferred prescription drugs to be used for the Medicaid program.

Existing(NRS law422.4025) requiresThe policies of the Department currently provide for the coverage of Healthany andtypical Humanor Servicesatypical toantipsychotic developmedication aor anticonvulsant medication that is not on the list of preferred prescription drugs toupon bethe useddemonstrated fortherapeutic thefailure Medicaid(Medicaid program.Services Manual 1203.1(B)(1)(h)) Section 1 of this bill codifies thisdicaid.

(NRSrequirement typicalin orlaw, atypicaland antipsychoticsections medication2 orand anticonvulsant4 medicationof thatthis isbill notclarify onthat the listrequirement ofapplies preferredto prescriptionhealth drugsmaintenance uponorganizations theand demonstratedother therapeuticmanaged failurecare oforganizations oneproviding drugcoverage on that list to adequatelyrecipients treat the condition of a recipient of Medicaid.

(Medicaid Services Manual 1203.1(B)(1)(h)) Section 13 of this bill codifiesauthorizes this requirement in law, and sections 2 and 4 of this bill clarify that the requirement applies to health maintenance organizations and other managed care organizations Commissioner of Insurance to suspend or revoke the certificate of authority of athea health maintenance organization that fails to comply with the requirement of section 2 to cover any typical or atypical antipsychotic medication ororent of anticonvulsant medication that is not on the list of preferred prescription drugs upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid.

The Commissioner would also be - *SB177* – 2 – authorized to take such action against other managed care organizations who fail to comply with the requirements of section 4.

(NRS 680A.200) THEEXPLANATION PEOPLE– OFMatter THEin STATEbolded OFitalics NEVADA,is REPRESENTEDnew; IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

matter between brackets [omitted material] is material to be omitted.

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

and (b)- Negotiate82nd andSession enter(2023) into– agreements2 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 a contract pursuant to NRS 422.4053 with a pharmacy benefit manager, health maintenance organization or one or more public or private entities in this State, the District of Columbia or other states or territories of the United States, as appropriate, to negotiate such agreements.

(b) Antirejection medications for organ transplants;

andandrgan (d)transplants; 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.

(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.

(b) Which therapeutically equivalent prescription drugs will be reviewed for inclusion on the list of preferred prescription drugs and - *SB177* – 3 – for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;

andand(c) (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.

and (b)- Prescription82nd drugsSession (2023) – 3 – immunodeficiency virus.gs to prevent the acquisition of human immunodeficiency5. virus.

5.

(a) Compile a report concerning the agreements negotiated pursuant to paragraph (b) of subsection 1 and contracts entered into pursuant to NRS 422.4053 which must include, without limitation, the financial effects of obtaining prescription drugs through those agreements and contracts, in total and aggregated separately forforose agreements negotiated by the Department, contracts with a pharmacy benefit manager, contracts with a health maintenance organization and contracts with public and private entities from this State, the District of Columbia and other states and territories of the United States;

A health maintenance organization that provides health care services to recipients of Medicaid under the State Plan for - *SB177* – 4 – Medicaid pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and HumanHumanh Care Services shall automatically cover any typical or atypical antipsychotic medication or anticonvulsant medication that is not on the list of preferred prescription drugs developed pursuant to NRS 422.4025 upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid.

- 82nd Session (2023) – 4 – Sec.

The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuant to the provisions of this chapter if the Commissioner finds tha(a) Thef thhealthowimaintenancens exorganization 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 ofother theinformation followingsubmitted conditionspursuant exist:to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

(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 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 into participate in matters relating to the content of programs pursuant to NRS 695C.110;

and - *SB177* – 5 – (2) Conducting external reviews of adverse determinations that comply with the provisions of NRS 695G.241 to 695G.310, inclusive;

- 82nd Session (2023) – 5 – (i) The continued operation of the health maintenance organization would be hazardous to its enrollees or creditors or to the general public;

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.

H~~~~~ 23 - *SB177*82nd Session (2023)