Section 14.2 of this bill makes a conforming change to update an internal reference changed by section 14.8.

Existing law requires a pharmacist to dispense up to a 12-month supply of contraceptives or therapeutic equivalent or any amount which covers the remainder of the plan year, whichever is less, pursuant to a valid prescription or order if:

(2) the patient has previously received a 9-month supply of the same drug or a supply of the same drug for the balance of the plan year in which the 3-month supply was prescribed or ordered, whichever is less;

(NRS 639.28075) [Section] If a patient is not currently using a contraceptive or therapeutic equivalent, section 15 of this bill [instead] requires a pharmacist to dispense a full 3-month supply or the amount designated by the prescription or order, whichever is less, pursuant to a valid prescription or order unless the patient is unable or unwilling to pay the applicable charge, copayment or coinsurance.

If the patient is currently using the contraceptive or therapeutic equivalent, section 15 requires a pharmacist to dispense a full 9-month supply or a full 12-month supply,supply [of contraceptives or therapeutic equivalent] , as applicable, any amount designated by the prescription or order or any amount which covers the remainder of the plan year, whichever is less, pursuant to a valid prescription or order unless the patient is unable or unwilling to pay the applicable charge, copayment or coinsurance.

- *SB352_R2* – 3 – THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

A health carrier which offers or issues a network plan:plan [must] :

(b) Shall provide to each covered person in this State a notice that meets the requirements prescribed by the regulations adopted pursuant to subsection 2 of each pharmacist and pharmacy that has entered into a provider network contract with the carrier to provide family planning services to covered persons who par2.ciTheparticipate Commissionerin shall adopt regulations to carry out the provisionsrelevant ofnetwork thisplan. section, including, without limitation, regulations prescribing requirements for:

(a)2. A health carrier to demonstrate compliance with paragraph (a) of subsection 1.

The Commissioner shall adopt regulations to carry out the provisions of this section, including, without limitation, regulations prescribing requirements for [a] :

Senate Amendment No.

245 to Senate Bill No.

352 Page 5 (a) A health carrier to demonstrate compliance with paragraph (a) of subsection 1.

- *SB352_R2* – 4 – Sec.

- *SB352_R2* – 5 – (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

(1)Senate LawfullyAmendment prescribedNo. or ordered;

245 to Senate Bill No.

352 Page 6 (1) Lawfully prescribed or ordered;

An insurerinsured shallis provideentitled coverageto reimbursement for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who [participates in the network plan of the insurer.] is employed by or serves as an independent contractor of an in-in-network network pharmacy.

Such coverage must be provided to the same extent as if the services were provided by another provider of health care.

- *SB352_R2* – 6 – [4.] 5.

Except as otherwise provided in subsection [7,] 8, a policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or afterSenate JanuaryAmendment 1,No. [2022,] 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.

245 to Senate Bill No.

352 Page 7 after January 1, [2022,] 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.

For each of the 18 methods of contraception listed in subsection [10] 11 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 the - *SB352_R2* – 7 – insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

or (b)Senate RequireAmendment anNo. insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

245 to Senate Bill No.

352 Page 8 (b) Require an insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

An insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an - *SB352_R2* – 8 – 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.

- *SB352_R2* – 9 – (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

2.Senate Amendment No.

An245 insurerto shallSenate provideBill coverageNo. for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in- network pharmacy.

Such352 coveragePage must9 be2. provided to the same extent as if the services were provided by another provider of health care.

An insured is entitled to reimbursement for services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who [participates in the network plan of the insurer.] is employed by or serves as an independent contractor of an in-network pharmacy.

- *SB352_R2* – 10 – (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

[8.]Senate 9.Amendment No.

245 to Senate Bill No.

352 Page 10 [8.] 9.

- *SB352_R2* – 11 – (a) Once for the entire amount of the drug dispensed for the plan year;

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 managementSenate techniqueAmendment usedNo. by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

245 to Senate Bill No.

352 Page 11 management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

- *SB352_R2* – 12 – (a) “In-network pharmacy” means a pharmacy that has entered into a contract with an insurer to provide services to insureds through a network plan offered or issued by the insurer.

- *SB352_R2* – 13 – (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

AAn carrierinsured shallis provideentitled coverageto reimbursement for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who [participates in the network plan of the carrier.] is employed by or serves as an independent contractor of an in-in-network network pharmacy.

Such coverage must be provided to the same extent as if the services were provided by another provider of health care.

(b)Senate ReimbursementAmendment forNo. services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

245 to Senate Bill No.

352 Page 12 (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

- *SB352_R2* – 14 – (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;

(a)Senate OnceAmendment forNo. the entire amount of the drug dispensed for the plan year;

245 to Senate Bill No.

352 Page 13 (a) Once for the entire amount of the drug dispensed for the plan year;

- *SB352_R2* – 15 – (h) Progestin-based drugs;

[(b)] (c) “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 under contract - *SB352_R2* – 16 – with the carrier.

[(c)]Senate (d)Amendment “ProviderNo. of health care” has the meaning ascribed to it in NRS 629.031.

245 to Senate Bill No.

352 Page 14 [(c)] (d) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

AAn societyinsured shallis provideentitled coverageto reimbursement for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who [participates in the network plan of] is employed by or serves as an independent contractor of an in-in-network network pharmacy or a pharmacy operated by the society.

Such coverage must be provided to the same extent as if the services - *SB352_R2* – 17 – were provided by another provider of health care.

(a)Senate RequireAmendment anNo. 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;

245 to Senate Bill No.

352 Page 15 (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;

Except as otherwise provided in subsection [7,] 8, a benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required - *SB352_R2* – 18 – by subsection 1, and any provision of the contract or the renewal which is in conflict with this section is void.

(j)Senate Estrogen-Amendment andNo. progestin-based patches;

245 to Senate Bill No.

352 Page 16 (j) Estrogen- and progestin-based patches;

- *SB352_R2* – 19 – (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

- *SB352_R2* – 20 – (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

(a)Senate UpAmendment toNo. a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

245 to Senate Bill No.

352 Page 17 (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

An insurerinsured shallis provideentitled coverageto reimbursement for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who [participates in the network plan of the hospital or medical services corporation.] is employed by or serves as an independent contractor of an in-in-network network pharmacy or a pharmacy operated by the insurer.

Such coverage must be provided to the same extent as if the services were provided by another provider of health care.

(b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount - *SB352_R2* – 21 – reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

(d)Senate PenalizeAmendment aNo. provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

245 to Senate Bill No.

352 Page 18 (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;

Such an insurer shall, - *SB352_R2* – 22 – 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.

(m)Senate SpongesAmendment withNo. spermicide;

245 to Senate Bill No.

352 Page 19 (m) Sponges with spermicide;

- *SB352_R2* – 23 – (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

- *SB352_R2* – 24 – (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

(1)Senate LawfullyAmendment prescribedNo. or ordered;

245 to Senate Bill No.

352 Page 20 (1) Lawfully prescribed or ordered;

AAn healthenrollee maintenanceis organizationentitled shallto providereimbursement coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who [participates in the network plan of] is employed by or serves as an independent contractor of an in-network pharmacy or a pharmacy operated by the health maintenance organization.

Such coverage must be provided to the same extent as if the services were provided by another provider of health care.

(b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount - *SB352_R2* – 25 – reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

or (f)Senate ImposeAmendment anyNo. other restrictions or delays on the access of an enrollee to any such benefit.

245 to Senate Bill No.

352 Page 21 (f) Impose any other restrictions or delays on the access of an enrollee to any such benefit.

Such an organization shall, before the issuance of - *SB352_R2* – 26 – a health care plan and before the renewal of such a plan, provide to the prospective enrollee written notice of the coverage that the health maintenance organization refuses to provide pursuant to this subsection.

- *SB352_R2* – 27 – (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

and (r)Senate UlipristalAmendment acetateNo. for emergency contraception.

245 to Senate Bill No.

352 Page 22 (r) Ulipristal acetate for emergency contraception.

- *SB352_R2* – 28 – (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

(b)Senate AnyAmendment typeNo. of device for contraception which is:

245 to Senate Bill No.

352 Page 23 (b) Any type of device for contraception which is:

AAn managedinsured careis organizationentitled shallto providereimbursement coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who [participates in the network plan of] is employed by or serves as an independent contractor of an in-network pharmacy or a pharmacy operated by the managed care organization.

Such coverage must be provided to the same extent as if the services were provided by another provider of health care.

(a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage - *SB352_R2* – 29 – for such services when provided by another provider of health care.

[6.]Senate 7.Amendment No.

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352 Page 24 [6.] 7.

- *SB352_R2* – 30 – [7.] 8.

- *SB352_R2* – 31 – (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

(a)Senate UseAmendment medicalNo. 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 [.

245 to Senate Bill No.

352 Page 25 (a) 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 [.

- *SB352_R2* – 32 – (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

2.Senate Amendment No.

245 to Senate Bill No.

352 Page 26 2.

For each method of contraception which is approved by the Food and Drug Administration, the Plan must include at least one - *SB352_R2* – 33 – contraceptive drug or device for which no deductible, copayment or coinsurance may be charged to the person enrolled in Medicaid, but the Plan may charge a deductible, copayment or coinsurance for any other contraceptive drug or device that provides the same method of contraception.

The Plan must provide for the reimbursement of a pharmacist for providing services described in subsection 1 that are within the scope of practice of the pharmacistpharmacist. to the same extent as if the services were provided by another provider of health care.

(b) “Provider“Therapeutic ofequivalent” healthmeans care”a hasdrug thewhich: meaning ascribed to it in NRS 629.031.

(c) “Therapeutic equivalent” means a drug which:

Except as otherwise provided in subsection 2, the Department shall directly manage, direct and coordinate all payments and rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under - *SB352_R2* – 34 – the State Plan for Medicaid and the Children’s Health Insurance Program.

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

245 to Senate Bill No.

352 Page 27 or recipients of insurance through the Children’s Health Insurance Program who receive coverage through a Medicaid managed care program.

- *SB352_R2* – 35 – Sec.

14.2.

NRS 454.221 is hereby amended to read as follows:

454.221 1.

A person who furnishes any dangerous drug except upon the prescription of a practitioner is guilty of a category D felony and shall be punished as provided in NRS 193.130, unless the dangerous drug was obtained originally by a legal prescription.

2.

The provisions of this section do not apply to the furnishing of any dangerous drug by:

(a) A practitioner to his or her patients;

(b) A physician assistant licensed pursuant to chapter 630 or 633 of NRS if authorized by the Board;

(c) A registered nurse while participating in a public health program approved by the Board, or an advanced practice registered nurse who holds a certificate from the State Board of Pharmacy permitting him or her to dispense dangerous drugs;

(d) A manufacturer or wholesaler or pharmacy to each other or to a practitioner or to a laboratory under records of sales and purchases that correctly give the date, the names and addresses of the supplier and the buyer, the drug and its quantity;

(e) A hospital pharmacy or a pharmacy so designated by a county health officer in a county whose population is 100,000 or more, or by a district health officer in any county within its jurisdiction or, in the absence of either, by the Chief Medical Officer or the Chief Medical Officer’s designated Medical Director of Emergency Medical Services, to a person or agency described in subsection [3] 4 of NRS 639.268 to stock ambulances or other authorized vehicles or replenish the stock;

or (f) A pharmacy in a correctional institution to a person designated by the Director of the Department of Corrections to administer a lethal injection to a person who has been sentenced to death.

14.8.

NRS 639.268 is hereby amended to read as follows:

639.268 1.

A practitioner may purchase supplies of controlled substances, poisons, dangerous drugs and devices from a pharmacy by:

(a) Making an oral order to the pharmacy or transmitting an oral order through his or her agent, except an order for a controlled substance in schedule II;

or (b) If the order is for a controlled substance, presenting to the pharmacy a written order signed by the practitioner which contains his or her registration number issued by the Drug Enforcement Administration.

2.

Any person or entity authorized to dispense controlled substances and dangerous drugs, including, without limitation, a pharmacy, institutional pharmacy or practitioner, may:

- *SB352_R2* – 36 – (a) Purchase or otherwise acquire controlled substances and dangerous drugs compounded or repackaged by an outsourcing facility directly from the outsourcing facility without an order from a practitioner other than, where applicable, the practitioner purchasing or acquiring the controlled substance or dangerous drug;

and (b) Administer and dispense controlled substances and dangerous drugs purchased or acquired pursuant to paragraph (a) to the same extent as controlled substances and dangerous drugs acquired through other authorized means.

3.

A hospital pharmacy or a pharmacy designated for this purpose by a county health officer in a county whose population is 100,000 or more, or by a district health officer in any county within its jurisdiction or, in the absence of either, by the Chief Medical Officer or his or her designated medical director of emergency medical services, may sell to a person or agency described in subsection [3] 4 supplies of controlled substances to stock the ambulances or other authorized vehicles of such a person or agency or replenish the stock if:

(a) The person or agency is registered with the Drug Enforcement Administration pursuant to 21 C.F.R.

Part 1301;

(b) The person in charge of the controlled substances is:

(1) A paramedic appropriately certified by the health authority;

(2) A registered nurse licensed by the State Board of Nursing;

or (3) A person who holds equivalent certification or licensure issued by another state;

and (c) Except as otherwise provided in this paragraph, the purchase order is countersigned by a physician or initiated by an oral order and may be made by the person or agency or transmitted by an agent of such a person or agency.

An order for a controlled substance listed in schedule II must be made pursuant to NRS 453.251.

[3.] 4.

A pharmacy, institutional pharmacy or other person licensed by the Board to furnish controlled substances and dangerous drugs may sell to:

(a) The holder of a permit issued pursuant to the provisions of NRS 450B.200 or 450B.210;

(b) The holder of a permit issued by another state which is substantially similar to a permit issued pursuant to the provisions of NRS 450B.200 or 450B.210;

and (c) An agency of the Federal Government that provides emergency care or transportation and is registered with the Drug Enforcement Administration pursuant to 21 C.F.R.

Part 1301.

- *SB352_R2* – 37 – [4.] 5.

A pharmacy, institutional pharmacy , outsourcing facility or other person licensed by the Board to furnish dangerous drugs who sells supplies pursuant to this section shall maintain a record of each sale which must contain:

(a) The date of sale;

(b) The name, address and signature of the purchaser or the person receiving the delivery;

(c) The name of the dispensing pharmacist [;] , where applicable;

(d) The name and address of the authorizing practitioner [;] , where applicable;

and (e) The name, strength and quantity of each drug sold.

[5.] 6.

A pharmacy, institutional pharmacy or other person licensed by the Board to furnish dangerous drugs who supplies the initial stock for an ambulance or other emergency vehicle shall comply with any applicable regulations adopted by the State Board of Health, or a district board of health, pursuant to NRS 450B.120.

[6.] 7.

The Board shall adopt regulations regarding the records a pharmacist shall keep of any purchase made pursuant to this section.

8.

As used in this section:

(a) “Compounding” includes, without limitation, the combining, admixing, mixing, pooling, reconstituting or other altering of a drug or bulk drug substance, as defined in 21 C.F.R.

§ 207.3, to create a drug.

(b) “Outsourcing facility” means a manufacturer at one geographic location or address that:

(1) Is engaged in the compounding of sterile or nonsterile drugs for use by humans;

and (2) Has registered with the Secretary of Health and Human Services as an outsourcing facility pursuant to 21 U.S.C.

§ 353b.

Sec.

Except as otherwise provided in [subsections] subsection 2 , [and 3,] pursuant to a valid prescription or order for a drug to be used for contraception or its therapeutic equivalent which has been approved by the Food and Drug Administration , a pharmacist shall:shall :

(b) [The second time dispensing] If the drug or therapeutic equivalent has only been dispensed to the patient [,] once pursuant - *SB352_R2* – 38 – to paragraph (a), dispense [up to] a 9-month supply of the drug or therapeutic equivalent, any amount designated by the prescription or order or any amount which covers the remainder of the plan year if the patient is covered by a health care plan, whichever is less.

(c) For a refill in a plan year following the initial dispensing of a drug or therapeutic equivalent pursuant to paragraphs (a) and (b), dispense [up to]to dispense] a 12-month supply of the drug or therapeutic equivalent , any amount designated by the prescription or order or any amount which covers the remainder of the plan year if the patient is covered by a health care plan, whichever is less.

and (b)Senate TheAmendment patientNo. is covered by the same health care plan.

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352 Page 28 (b) The patient is covered by the same health care plan.

- *SB352_R2* – 39 – Sec.

additional expenses of a local government that are related to the provisions of this act.

17.

The provisions of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.

Sec.

This section andbecomes sections 14.2 and 14.8 of this act become effective upon passage and approval.

Sections 1 to 14,17, inclusive, 15, 16 and 17 of this act become effective:

H - *SB352_R2*