AB 186 — Revises provisions governing pharmacists. (BDR 54-344)

(3) A program for hospice care or palliative care;

or (4) A program for treatment for substance use disorder.

(c) Controlled substance that is an opioid.

(b) Establishing the scope of the ability for a registered pharmacist to prescribe drugs and devices and dispense refills as authorized by subsection 1;

and - *AB186_R1* – 4 – (c) Establishing the standard of care required of a registered pharmacist who prescribes drugs and devices and dispenses refills as authorized by subsection 1.

As used in this section,section: “self-limiting” means a health condition that generally persists for a limited period of time.

(a) “Medical facility” has the meaning ascribed to it in NRS 449.0151.

(b) “Program of hospice care” means a program of hospice care described in NRS 449.196.

(c) “Self-limiting” means that a health condition generally persists for a limited period of time.

(h) Development of written guidelines and protocols in collaboration with a practitioner which authorize collaborative drug - *AB186* – 4 – therapy management.

- *AB186_R1* – 5 – (m) Ordering and performing laboratory tests in accordance with NRS 639.2808.

(n) Prescribing and dispensing drugs and devices and dispensing refills without the authorization of a practitioner, other than a pharmacist, in accordance with section 1 of this act.

and (b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or - *AB186* – 5 – devices under the supervision of an osteopathic physician as required by chapter 633 of NRS;

and - *AB186_R1* – 6 – (c) Holds a certificate issued pursuant to NRS 639.1374 by the State Board of Pharmacy authorizing him or her to so prescribe;

A pharmacist who is[is] registered: pursuant to NRS 639.28079 to prescribe and dispense drugs for medication-assisted treatment [;] or who prescribes drugs or devices in accordance with section 1 of this act;

(a) Is registered pursuant to NRS 639.28079 to prescribe and dispense drugs for medication-assisted treatment;

or (b) Prescribes drugs or devices or dispenses refills without the authorization of a practitioner, other than a pharmacist, in accordance with section 1 of this act;

and - *AB186* – 6 – (b) Perform any laboratory test that is classified as a waived test under 42 C.F.R.

The performance of such a test must be in compliance with standards of practice recommended by the [American] Association of Diabetes [Educators] Care and - *AB186_R1* – 7 – Education Specialists or its successor organization.

- *AB186* – 7 – 3.

or - *AB186_R1* – 8 – (II) Categorized as a provider-performed microscopy procedure pursuant to 42 C.F.R.

The governing body of any county, school district, municipal corporation, political subdivision, public corporation or - *AB186* – 8 – other local governmental agency of the State of Nevada that provides health insurance through a plan of self-insurance shall ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the governing body.

- *AB186_R1* – 9 – (a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.

or - *AB186* – 9 – (2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation.

- *AB186_R1* – 10 – Sec.

- *AB186* – 10 – 8.

A pharmacist who is[is] registered: pursuant to NRS 639.28079 to prescribe and dispense drugs for medication-assisted treatment [.] or who prescribes and dispenses drugs or devices in accordance with section 1 of this act.

(a) Is registered pursuant to NRS 639.28079 to prescribe and dispense drugs for medication-assisted treatment [.] ;

or (b) Prescribes and dispenses drugs or devices or dispenses refills without the authorization of a practitioner, other than a pharmacist, in accordance with section 1 of this act.

- *AB186_R1* – 11 – (a) An order given individually for the person for whom prescribed, directly from a physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, optometrist, advanced practice registered nurse, certified registered nurse anesthetist, pharmacist registered pursuant to NRS 639.28079 or acting in accordance with section 1 of this act or veterinarian, or his or her agent, to a pharmacist or indirectly by means of an order signed by the practitioner or an electronic transmission from the practitioner to a pharmacist;

- *AB186* – 11 – (b) A common or contract carrier or warehouseman, or an employee thereof, whose possession of any controlled substance is in the usual course of business or employment;

- *AB186_R1* – 12 – (1) Holds a locum tenens license issued by the Board of Medical Examiners or a temporary license issued by the State Board of Osteopathic Medicine;

(a) For a first or second offense, if the controlled substance is listed in schedule I or II and the quantity possessed is less than 14 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is less than 28 grams, is guilty of possession of a controlled substance and shall be punished for a - *AB186* – 12 – category E felony as provided in NRS 193.130.

(b) For a third or subsequent offense, if the controlled substance is listed in schedule I or II and the quantity possessed is less than 14 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is less than 28 grams, or if the offender has previously been convicted two or more times in the aggregate of any violation of the law of the United States or of any state, territory or district relating to a controlled substance, is guilty of possession of a controlled substance and shall be punished for a category D - *AB186_R1* – 13 – felony as provided in NRS 193.130, and may be further punished by a fine of not more than $20,000.

- *AB186* – 13 – (b) Attending the live meeting described in paragraph (a) of subsection 2 of NRS 484C.530 and complying with any other requirements set forth in that section;

Unless a greater penalty is provided pursuant to NRS 212.160, a person who is convicted of the possession of more than 1 ounce, but less than 50 pounds, of marijuana or more than one- eighth of an ounce, but less than one pound, of concentrated - *AB186_R1* – 14 – cannabis is guilty of a category E felony and shall be punished as provided in NRS 193.130.

- *AB186* – 14 – (I) The State Board of Health in a county whose population is less than 100,000;

or - *AB186_R1* – 15 – (III) A district board of health created pursuant to NRS 439.362 or 439.370 in any county.

(k) In accordance with applicable regulations of the State Board of Pharmacy, an animal control officer, a wildlife biologist or an employee designated by a federal, state or local governmental - *AB186* – 15 – agency whose duties include the control of domestic, wild and predatory animals.

- *AB186_R1* – 16 – (m) A registered pharmacist .

- *AB186* – 16 – 4.

Any person who has obtained from a physician, physician assistant, dentist, advanced practice registered nurse, certified registered nurse anesthetist, podiatric physician, pharmacist registered pursuant to NRS 639.28079 or acting in accordance with - *AB186_R1* – 17 – section 1 of this act or veterinarian any controlled substance for administration to a patient during the absence of the physician, physician assistant, dentist, advanced practice registered nurse, certified registered nurse anesthetist, podiatric physician, pharmacist or veterinarian shall return to him or her any unused portion of the substance when it is no longer required by the patient.

An optometrist who is certified to prescribe and administer pharmaceutical agents pursuant to NRS 636.288 when the - *AB186* – 17 – optometrist prescribes or administers dangerous drugs which are within the scope of his or her certification.

- *AB186_R1* – 18 – 6.

A pharmacist who is[is] registered: pursuant to NRS 639.28079 to prescribe and dispense drugs for medication-assisted treatment [.] or who prescribes and dispenses drugs or devices in accordance with section 1 of this act.

(a) Is registered pursuant to NRS 639.28079 to prescribe and dispense drugs for medication-assisted treatment [.] ;

or (b) Prescribes and dispenses drugs or devices or dispenses refills without the authorization of a practitioner, other than a pharmacist, in accordance with section 1 of this act.

As used in this paragraph, - *AB186* – 18 – “designated facility” has the meaning ascribed to it in NRS 632.0145.

- *AB186_R1* – 19 – (1) The State Board of Health in a county whose population is less than 100,000;

- *AB186* – 19 – (o) A physical therapist, but only if the drug or medicine is a topical drug which is:

or - *AB186_R1* – 20 – (II) The transmission of drugs through the skin using ultrasound.

- *AB186* – 20 – [(u)] (t) A medical assistant, in accordance with applicable regulations of the:

- *AB186_R1* – 21 – (2) State Board of Osteopathic Medicine, at the direction of the prescribing physician and under the supervision of a physician or physician assistant.

(b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the insurer for any service to test for, prevent or treat human immunodeficiency virus - *AB186* – 21 – or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.

- *AB186_R1* – 22 – (b) Limit the covered amount of a drug described in paragraph (a) of subsection 1;

(a) All drugs approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus or treating human immunodeficiency virus - *AB186* – 22 – or hepatitis C in the form recommended by the prescribing practitioner, regardless of whether the drug is included in the formulary of the insurer;

- *AB186_R1* – 23 – (c) Any service to test for, prevent or treat human immunodeficiency virus or hepatitis C provided by a provider of primary care if the service is covered when provided by a specialist and:

A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or - *AB186* – 23 – after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.

- *AB186_R1* – 24 – (a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.

- *AB186* – 24 – 2.

(a) A pharmacist who participates in the health benefit plan of the carrier for the services described in [NRS 639.28085] paragraph - *AB186_R1* – 25 – (d) of subsection 1 at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

- *AB186* – 25 – (c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

- *AB186_R1* – 26 – Sec.

- *AB186* – 26 – (b) Limit the covered amount of a drug described in paragraph (a) of subsection 1;

or - *AB186_R1* – 27 – (d) Prohibit or restrict access to any service or drug to treat human immunodeficiency virus or hepatitis C on the same day on which the insured is diagnosed.

- *AB186* – 27 – (b) Laboratory testing that is necessary for therapy using a drug to prevent the acquisition of human immunodeficiency virus;

- *AB186_R1* – 28 – (1) The service is within the scope of practice of the provider of primary care;

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after - *AB186* – 28 – January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.

(a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription - *AB186_R1* – 29 – drugs.

and (d) [The] Ordering laboratory testing described in paragraph (b) and the services described in NRS 639.28085, when provided by - *AB186* – 29 – a pharmacist who participates in the network plan of the health maintenance organization.

(a) A pharmacist who participates in the network plan of the health maintenance organization for the services described in [NRS 639.28085] paragraph (d) of subsection 1 at a rate equal to the rate - *AB186_R1* – 30 – of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

(b) “Network plan” means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers - *AB186* – 30 – under contract with the health maintenance organization.

- *AB186_R1* – 31 – Sec.

- *AB186* – 31 – (a) Subject the benefits required by subsection 1 to medical management techniques, other than step therapy;

or - *AB186_R1* – 32 – (d) Prohibit or restrict access to any service or drug to treat human immunodeficiency virus or hepatitis C on the same day on which the insured is diagnosed.

and - *AB186* – 32 – (b) On January 1, 2026, for all other purposes.

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