SB 316 — Revises provisions relating to insurance. (BDR 57-777)

(NRS 598.0999) Section 18 makes certain violations of sections 15 and 24 a deceptive trade practice, thereby subjecting a violation of those provisions to additional penalties.

give rise to a private right of action.

bill provide that such violations do not THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

On or before June 1 of each year, a health insurer that provides coverage for prescription drugs shall compile and submit to the Commissioner a report which contains the following information:

and (3) The 25 prescription drugs with the largest increase in the percentage of spending on prescription drugs in this State by - *SB316_R2* – 4 – the health insurer in the immediately preceding year, as compared to the previous year;

- *SB316_R1* – 5 – (3) The aggregate amount of administrative fees received by a pharmacy benefit manager under contract with the insurer relating to the distribution of the drug to insureds in this State;

- *SB316_R2* – 5 – (a) “Affiliated pharmacy” has the meaning ascribed to it in section 3 of this act.

(b) “Health insurer” means any insurer or organization authorized pursuant to this title to conduct business in this State that provides or arranges for the provision of health care services, including, without limitation, an insurer that issues a policy of health insurance, an insurer that issues a policy of group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical services corporation, a health maintenance organization, a plan for dental care, a prepaid - *SB316_R1* – 6 – limited health service organization and a managed care organization.

“Cost-sharing obligation” includes, without limitation, a copayment, coinsurance or deductible imposed upon - *SB316_R2* – 6 – or collected from a covered person in connection with filling a prescription or obtaining other pharmacist services.

- *SB316_R1* – 7 – Sec.

- *SB316_R2* – 7 – Sec.

- *SB316_R1* – 8 – (a) Require a covered person to use an affiliated pharmacy to fill a prescription or obtain other pharmacist services if there is a nonaffiliated pharmacy in the applicable network;

or (f) Deny a pharmacy the opportunity to participate in a network or receive a preferred status if the pharmacy is willing to - *SB316_R2* – 8 – accept the same terms and conditions that the pharmacy benefit manager has established for affiliated pharmacies as a condition for participating in the network or receiving preferred status, as applicable.

Upon the request of a third party for which the pharmacy benefit manager manages a pharmacy benefits plan, shall disclose to the third party, in writing, the amounts and types of charges, fees and commissions in the aggregate that the pharmacy benefit - *SB316_R1* – 9 – manager charges the third party for providing pharmacy benefit management services or otherwise receives in connection with managing the pharmacy benefits plan of the third party, including, without limitation, administrative fees and rebates collected from pharmacies, manufacturers and wholesalers.

(Deleted1. by amendment.) Sec.

A pharmacy benefit manager shall not derive income from providing pharmacy benefit management services in this State except for income derived from administrative fees paid by the third party with which the pharmacy benefit manager has entered into an agreement to provide pharmacy benefit management services.

Such administrative fees must be set forth in the agreement between the pharmacy benefit manager and the third party.

2.

A pharmacy benefit manager shall provide:

(a) Any income generated through discounts offered by a manufacturer or wholesaler and any fees or other incentives collected from a manufacturer or wholesaler in connection with providing pharmacy benefit management services for a third party to the third party to which the discount, fee or other incentive pertains;

and (b) Any income generated through rebates received from a manufacturer or wholesaler in connection with providing pharmacy benefit management services to covered persons.

Sec.

- *SB316_R1* – 10 – (d) Make or disseminate any statement, representation or advertisement that is, or reasonably should be known to be, untrue, deceptive or misleading.

As used in this section, “contract pharmacy” means a pharmacy that contracts directly with a pharmacy benefit - *SB316_R2* – 9 – manager, or indirectly with a pharmacy benefit manager through a pharmacy services administrative organization.

Except as otherwise provided in this subsection, a violation of paragraph (l) of subsection 1 of NRS 683A.179 or section 15 of this act constitutes a deceptive trade practice for the purposes of NRS 598.0903 to 598.0999, inclusive.

This subsection does not create a private right of action.

3.

3.

The remedies and penalties set forth in this section are not exclusive and are in addition to any other remedies and penalties provided by law.

The remedies and penalties set forth in this section are not exclusive and are in addition to any other remedies and penalties provided by law.

5.

- *SB316_R1* – 11 – (a) A report which includes the information prescribed by subsection 2;

(1) The 2550 prescription drugs with the highest wholesale acquisition costs at the time the report is submitted;

- *SB316_R2* – 10 – (2) The 2550 prescription drugs most frequently prescribed to covered persons in this State during the immediately preceding calendar year;

and (3) The 2550 prescription drugs which produced the largest amount of revenue for the pharmacy benefit manager in this State during the immediately preceding calendar year.

- *SB316_R1* – 12 – (d) For each prescription drug appearing on a list compiled pursuant to paragraph (a), the aggregate amount for the immediately preceding year of the:

- *SB316_R2* – 11 – (4) Amount paid or reimbursed to affiliated pharmacies in this State for the drug;

- *SB316_R1* – 13 – 3.

- *SB316_R2* – 12 – (b) Submit the report to the Director of the Legislative Counsel Bureau for transmittal to the Joint Interim Standing Committee on Health and Human Services and the Joint Interim Standing Committee on Commerce and Labor.

- *SB316_R1* – 14 – Sec.

[AA participating[participating public agency, as that term is defined in NRS 287.04052, and any otherother] local governmental agency of the - *SB316_R2* – 13 – State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS;

4.]or The4. Public Option established pursuant to NRS 695K.200;

orThe [5.]public 4.option established pursuant to NRS 695K.200;

or 5.

 The term does not include the Public Employees’ Benefits Program,Program a local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS or an insurer that provides coverage under a policy of casualty or property insurance.

(a) Recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of - *SB316_R1* – 15 – the Department of Health and Human Services entered into pursuant to NRS 422.273;

or (b) Members of the Public Employees’ Benefits Program;Program.

or (c) The officers and employees, and the dependents of officers and employees, of the governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of this State.

- *SB316_R2* – 14 – (a) A fiduciary duty to persons covered by a third party with which the pharmacy benefit manager has entered into an agreement to provide pharmacy benefit management services;

and (b) ExceptAn as otherwise provided in subsection 2, an obligation of good faith and fair dealing toward a third party or pharmacy when performing duties pursuant to a contract to which the pharmacy benefit manager is a party.

If the duties established in paragraphs (a) and (b) of subsection 1 conflict, the duty established in paragraph (a) of subsection 1 supersedes the duty established in paragraph (b) of subsection 1.

3.

[3.]3. 4.

5.4.

6.5.

- *SB316_R2**SB316_R1* – 1516 – (1) The amount of any copayment or coinsurance for a prescription drug;

or (3) The pharmacy or pharmacist that submitted the claim did not properly render the pharmacist services to which the claim relates;

- *SB316_R1* – 17 – (k) Refuse to pay a claim after terminating a contract with a pharmacy, except where the pharmacy benefit manager is investigating possible insurance fraud;

or - *SB316_R2* – 16 – (l) Retaliate against a pharmacy for reporting a potential or actual violation of this title or attempting to settle a dispute with a pharmacy benefit manager based on a potential or actual violation of this title.

An insurer that offers or issues a policy of health insurance which provides coverage for prescription drugsdrugs: shall not impose a cost-sharing obligation against an insured for a prescription drug that exceeds the net price paid for the drug.

Any(a) suchShall not impose a cost-sharing obligation mustagainst bean calculatedinsured atfor a prescription drug that exceeds the point-of-sale.net amount that the insurer pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

(b) Shall include all amounts paid by an insured or another person on behalf of an insured towards the cost of a covered prescription drug when calculating the cost-sharing obligation of - *SB316_R1* – 18 – the insured for the drug or the maximum out-of-pocket expense that the insured is required to pay for prescription drugs if:

(1) The drug does not have a generic equivalent;

or (2) The drug has a generic equivalent and the insured has:

(I) Obtained prior authorization, if required by the insurer;

(II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the insurer for coverage of the prescription drug, including, without limitation, through an exception, an appeals process established by the insurer or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223 (c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan ininsured sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the insured is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 an insurer or a pharmacy benefit manager with which an insurer has contracted, inclusive of anythis rebatesact. received for the prescription drug.

-(c) *SB316_R2*“Generic –equivalent” 17means –a (c)prescription “Pharmacydrug benefitthat manager”is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d) “Rebate” has the meaning ascribed to it in section 13 of this act.

An insurer that offers or issues a policy of group health insurance which provides coverage for prescription drugsdrugs: shall not impose a cost-sharing obligation against an insured for a prescription drug that exceeds the net price paid for the drug.

Any(a) suchShall not impose a cost-sharing obligation mustagainst bean calculatedinsured atfor a prescription drug that exceeds the point-of-sale.net amount that the insurer pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

- *SB316_R1* – 19 – (b) Shall include all amounts paid by an insured or another person on behalf of an insured towards the cost of a covered prescription drug when calculating the cost-sharing obligation of the insured for the drug or the maximum out-of-pocket expense that the insured is required to pay for prescription drugs if:

(1) The drug does not have a generic equivalent;

or (2) The drug has a generic equivalent and the insured has:

(I) Obtained prior authorization, if required by the insurer;

(II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the insurer for coverage of the prescription drug, including, without limitation, through an exception, an appeals process established by the insurer or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223(c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan ininsured sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the insured is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 an insurer or a pharmacy benefit manager with which an insurer has contracted, inclusive of anythis rebatesact. received for the prescription drug.

(c) “Pharmacy“Generic benefitequivalent” manager”means a prescription drug that is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d) “Rebate” has the meaning ascribed to it in section 13 of this act.

A carrier that offers or issues a health benefit plan which provides coverage for prescription drugsdrugs: shall not impose a cost- sharing obligation against an insured for a prescription drug that exceeds the net price paid for the drug.

Any(a) suchShall not impose a cost-sharing obligation mustagainst bean calculatedinsured atfor a prescription drug that exceeds the point-of-sale.net amount that the carrier pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

(b) Shall include all amounts paid by an insured or another person on behalf of an insured towards the cost of a covered prescription drug when calculating the cost-sharing obligation of the insured for the drug or the maximum out-of-pocket expense that the insured is required to pay for prescription drugs if:

(1) The drug does not have a generic equivalent;

or - *SB316_R1* – 20 – (2) The drug has a generic equivalent and the insured has:

(I) Obtained prior authorization, if required by the carrier;

(II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the carrier for coverage of the prescription drug, including, without limitation, through an exception, an appeals process established by the carrier or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223(c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan ininsured sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the insured is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 a carrier or a pharmacy benefit manager with which a carrier has contracted, inclusive of anythis rebatesact. received for the prescription drug.

-(c) *SB316_R2*“Generic –equivalent” 18means –a (c)prescription “Pharmacydrug benefitthat manager”is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d) “Rebate” has the meaning ascribed to it in section 13 of this act.

A society that offers or issues a benefit contract which provides coverage for prescription drugsdrugs: shall not impose a cost- sharing obligation against an insured for a prescription drug that exceeds the net price paid for the drug.

Any(a) suchShall not impose a cost-sharing obligation mustagainst bean calculatedinsured atfor a prescription drug that exceeds the point-of-sale.net amount that the society pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

(b) Shall include all amounts paid by an insured or another person on behalf of an insured towards the cost of a covered prescription drug when calculating the cost-sharing obligation of the insured for the drug or the maximum out-of-pocket expense that the insured is required to pay for prescription drugs if:

- *SB316_R1* – 21 – (1) The drug does not have a generic equivalent;

or (2) The drug has a generic equivalent and the insured has:

(I) Obtained prior authorization, if required by the society;

(II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the society for coverage of the prescription drug, including, without limitation, through an exception, an appeals process established by the society or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223(c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan ininsured sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the insured is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 a society or a pharmacy benefit manager with which a society has contracted, inclusive of anythis rebatesact. received for the prescription drug.

(c) “Pharmacy“Generic benefitequivalent” manager”means a prescription drug that is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d) “Rebate” has the meaning ascribed to it in section 13 of this act.

A hospital or medical services corporation that offers or issues a policy of health insurance which provides coverage for prescription drugsdrugs: shall not impose a cost-sharing obligation against an insured for a prescription drug that exceeds the net price paid for the drug.

Any(a) suchShall not impose a cost-sharing obligation mustagainst bean calculatedinsured atfor a prescription drug that exceeds the point-of-sale.net amount that the hospital or medical services corporation pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

(b) Shall include all amounts paid by an insured or another person on behalf of an insured towards the cost of a covered prescription drug when calculating the cost-sharing obligation of the insured for the drug or the maximum out-of-pocket expense that the insured is required to pay for prescription drugs if:

(1) The drug does not have a generic equivalent;

or (2) The drug has a generic equivalent and the insured has:

(I) Obtained prior authorization, if required by the hospital or medical services corporation;

- *SB316_R1* – 22 – (II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the hospital or medical services corporation for coverage of the prescription drug, including, without limitation, through an exception, an appeals process established by the hospital or medical services corporation or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223(c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan ininsured sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the insured is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 a hospital or medical services corporation or a pharmacy benefit manager with which a hospital or medical services corporation has contracted, inclusive of anythis rebatesact. received for the prescription drug.

-(c) *SB316_R2*“Generic –equivalent” 19means –a (c)prescription “Pharmacydrug benefitthat manager”is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d) “Rebate” has the meaning ascribed to it in section 13 of this act.

A health maintenance organization that offers or issues a health care plan which provides coverage for prescription drugsdrugs: shall not impose a cost-sharing obligation against an enrollee for a prescription drug that exceeds the net price paid for the drug.

Any(a) suchShall not impose a cost-sharing obligation mustagainst bean calculatedenrollee atfor a prescription drug that exceeds the point-of-sale.net amount that the health maintenance organization pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

(b) Shall include all amounts paid by an enrollee or another person on behalf of an enrollee towards the cost of a covered prescription drug when calculating the cost-sharing obligation of the enrollee for the drug or the maximum out-of-pocket expense that the enrollee is required to pay for prescription drugs if:

(1) The drug does not have a generic equivalent;

or (2) The drug has a generic equivalent and the enrollee has:

(I) Obtained prior authorization, if required by the health maintenance organization;

(II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the health maintenance organization for coverage of the prescription drug, including, without limitation, through an exception, an appeals - *SB316_R1* – 23 – process established by the health maintenance organization or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223(c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan inenrollee sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the enrollee is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 a health maintenance organization or a pharmacy benefit manager with which a health maintenance organization has contracted, inclusive of anythis rebatesact. received for the prescription drug.

(c) “Pharmacy“Generic benefitequivalent” manager”means a prescription drug that is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d) “Rebate” has the meaning ascribed to it in section 13 of this act.

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.1759, 695C.176 to 695C.200, inclusive, and 695C.265 and section 32 of this act do not apply to a health maintenance organization that provides health care services - *SB316_R2* – 20 – through managed care 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.

- *SB316_R1* – 24 – 5.

(b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of NRS 695C.1691 to - *SB316_R2* – 21 – 695C.200, inclusive, and section 32 of this act or 695C.204 or 695C.207;

or - *SB316_R1* – 25 – (2) Is unable to fulfill its obligations to furnish health care services as required under its health care plan;

If the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may be - *SB316_R2* – 22 – essential to the orderly conclusion of the affairs of the organization.

- *SB316_R1* – 26 – Sec.

A prepaid limited health service organization that provides coverage for prescription drugsdrugs: shall not impose a cost-sharing obligation against an enrollee for a prescription drug that exceeds the net price paid for the drug.

Any(a) suchShall not impose a cost-sharing obligation mustagainst bean calculatedenrollee atfor a prescription drug that exceeds the point-of-sale.net amount that the prepaid limited health service organization pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

(b) Shall include all amounts paid by an enrollee or another person on behalf of an enrollee towards the cost of a covered prescription drug when calculating the cost-sharing obligation of the enrollee for the drug or the maximum out-of-pocket expense that the enrollee is required to pay for prescription drugs if:

(1) The drug does not have a generic equivalent;

or (2) The drug has a generic equivalent and the enrollee has:

(I) Obtained prior authorization, if required by the prepaid limited health service organization;

(II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the prepaid limited health service organization for coverage of the prescription drug, including, without limitation, through an exception, an appeals process established by the prepaid limited health service organization or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223(c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan inenrollee sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the enrollee is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 a prepaid limited health service organization or a pharmacy benefit manager with which a prepaid limited health service organization has contracted, inclusive of anythis rebatesact. received for the prescription drug.

(c) “Pharmacy“Generic benefitequivalent” manager”means a prescription drug that is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d) “Rebate” has the meaning ascribed to it in section 13 of this act.

A managed care organization that offers or issues a health care plan which provides coverage for prescription drugsdrugs: shall not impose a cost-sharing obligation against an insured for a prescription drug that exceeds the net price paid for the drug.

Any- such*SB316_R1* – 27 – (a) Shall not impose a cost-sharing obligation mustagainst bean calculatedinsured atfor a prescription drug that exceeds the point-of-sale.net amount that the managed care organization pays for the drug, inclusive of any rebate received from a pharmacy benefit manager in connection with providing coverage for the drug.

(b) Shall include all amounts paid by an insured or another person on behalf of an insured towards the cost of a covered prescription drug when calculating the cost-sharing obligation of the insured for the drug or the maximum out-of-pocket expense that the insured is required to pay for prescription drugs if:

(1) The drug does not have a generic equivalent;

or (2) The drug has a generic equivalent and the insured has:

(I) Obtained prior authorization, if required by the managed care organization;

(II) Complied with any required step therapy protocol;

or (III) Otherwise received approval from the managed care organization for coverage of the prescription drug, including, without limitation, through an exception, an appeals process established by the managed care organization or other review process.

The provisions of paragraph (b) of subsection 1 do not apply with respect to the required deductible of a high deductible health plan, as defined in 26 U.S.C.

§ 223(c)(2).

3.

(a) “Cost-sharing“Amounts obligation”paid” hasincludes, thewithout meaninglimitation, ascribeda discount, incentive, coupon or other assistance provided to itan ininsured sectionby 6a manufacturer or wholesaler of thisa act.prescription drug which is meant to reduce the out-of-pocket cost that the insured is required to pay for a prescription drug at the point of sale.

(b) “Net“Cost-sharing priceobligation” paid”has means the pricemeaning paidascribed forto ait prescriptionin drugsection by6 a managed care organization or a pharmacy benefit manager with which a managed care organization has contracted, inclusive of anythis rebatesact. received for the prescription drug.

(c) “Pharmacy“Generic benefitequivalent” manager”means a prescription drug that is biologically equivalent and has the meaningsame ascribedactive toingredient itor iningredients NRSof 683A.174.the same strength, quantity and form of dosage as a drug with a brand name.

(d)Sec. “Rebate” has the meaning ascribed to it in section 13 of this act.

- *SB316_R2* – 23 – Sec.

- *SB316_R1* – 28 – 2.

(DeletedNRS by41.600 amendment.)is Sec.hereby amended to read as follows:

41.600 1.

[An] Except as otherwise provided in section 18 of this act, an action may be brought by any person who is a victim of consumer fraud.

2.

As used in this section, “consumer fraud” means:

(a) An unlawful act as defined in NRS 119.330;

(b) An unlawful act as defined in NRS 205.2747;

(c) An act prohibited by NRS 482.36655 to 482.36667, inclusive;

(d) An act prohibited by NRS 482.351;

(e) A deceptive trade practice as defined in NRS 598.0915 to 598.0925, inclusive;

or (f) A violation of NRS 417.133 or 417.135.

3.

If the claimant is the prevailing party, the court shall award the claimant:

(a) Any damages that the claimant has sustained;

(b) Any equitable relief that the court deems appropriate;

and (c) The claimant’s costs in the action and reasonable attorney’s fees.

4.

Any action brought pursuant to this section is not an action upon any contract underlying the original transaction.

Sec.

Except as otherwise provided in this section and NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, - *SB316_R1* – 29 – 62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 130.712, 136.050, 159.044, 159A.044, 164.041, 172.075, 172.245, 176.01334, 176.01385, 176.015, 176.0625, 176.09129, 176.156, 176A.630, 178.39801, 178.4715, 178.5691, 178.5717, 179.495, - *SB316_R2* – 24 – 179A.070, 179A.165, 179D.160, 180.600, 200.3771, 200.3772, 200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 218G.615, 224.240, 226.462, 226.796, 228.270, 228.450, 228.495, 228.570, 231.069, 231.1285, 231.1473, 232.1369, 233.190, 237.300, 239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 239C.420, 240.007, 241.020, 241.030, 241.039, 242.105, 244.264, 244.335, 247.540, 247.545, 247.550, 247.560, 250.087, 250.130, 250.140, 250.145, 250.150, 268.095, 268.0978, 268.490, 268.910, 269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 284.4086, 286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 293.906, 293.908, 293.909, 293.910, 293B.135, 293D.510, 331.110, 332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 353A.049, 353A.085, 353A.100, 353C.240, 353D.250, 360.240, 360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 396.159, 396.3295, 396.405, 396.525, 396.535, 396.9685, 398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 425.400, 427A.1236, 427A.872, 427A.940, 432.028, 432.205, 432B.175, 432B.280, 432B.290, 432B.4018, 432B.407, 432B.430, 432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, - *SB316_R1* – 30 – 439.4941, 439.4988, 439.5282, 439.840, 439.914, 439A.116, 439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 442.774, 445A.665, 445B.570, 445B.7773, 449.209, 449.245, 449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 483.575, 483.659, 483.800, 484A.469, 484B.830, 484B.833, 484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, - *SB316_R2* – 25 – 571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 604D.500, 604D.600, 612.265, 616B.012, 616B.015, 616B.315, 616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 628B.760, 629.043, 629.047, 629.069, 630.133, 630.2671, 630.2672, 630.2673, 630.2687, 630.30665, 630.336, 630A.327, 630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 632.3423, 632.405, 633.283, 633.301, 633.427, 633.4715, 633.4716, 633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 634A.185, 634B.730, 635.111, 635.158, 636.262, 636.342, 637.085, 637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 639.2485, 639.570, 640.075, 640.152, 640A.185, 640A.220, 640B.405, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 641.221, 641.2215, 641A.191, 641A.217, 641A.262, 641B.170, 641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D.320, 642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 669.285, 669A.310, 670B.680, 671.365, 671.415, 673.450, 673.480, 675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 711.600, and sections 1 and 19 of this act, sections 35, 38 and 41 of chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, Statutes of Nevada 2013 and unless otherwise declared by law to be - *SB316_R1* – 31 – confidential, all public books and public records of a governmental entity must be open at all times during office hours to inspection by any person, and may be fully copied or an abstract or memorandum may be prepared from those public books and public records.

- *SB316_R2* – 26 – 2.

(b) Except as otherwise provided in NRS 239.030, shall, upon request, prepare the copy of the public record and shall not require - *SB316_R1* – 32 – the person who has requested the copy to prepare the copy himself or herself.

(DeletedNRS by287.010 amendment.)is Sec.hereby amended to read as follows:

287.010 1.

The governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada may:

(a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on the insurance.

(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 upon the premiums.

(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.

The money accumulated for this purpose through deductions from the compensation of officers and employees and contributions of the governing body must be maintained as an internal service fund as defined by NRS 354.543.

The money must be deposited in a state or national bank or credit union authorized to transact business in the State of Nevada.

Any independent administrator of a fund created under this section is subject to the licensing requirements of chapter 683A of NRS, and must be a resident of this State.

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.

The provisions of NRS 439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs (b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 and 689B.500 and section 27 of this act apply to coverage provided pursuant to this paragraph, except that the provisions of - *SB316_R1* – 33 – 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.

(d) Defray part or all of the cost of maintenance of a self- insurance fund or of the premiums upon insurance.

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

2.

If a school district offers group insurance to its officers and employees pursuant to this section, members of the board of trustees of the school district must not be excluded from participating in the group insurance.

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.

3.

In any county in which a legal services organization exists, the governing body of the county, or of any school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada in the county, may enter into a contract with the legal services organization pursuant to which the officers and employees of the legal services organization, and the dependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the officers and employees, and the dependents of the officers and employees, of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency.

4.

If a contract is entered into pursuant to subsection 3, the officers and employees of the legal services organization:

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

and (b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which they authorize the purchase.

5.

A contract that is entered into pursuant to subsection 3:

(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.

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

- *SB316_R1* – 34 – 6.

As used in this section, “legal services organization” means an organization that operates a program for legal aid and receives money pursuant to NRS 19.031.

Sec.

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to - *SB316_R2* – 27 – 695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, inclusive, other than section 36 of this act, 695G.241 to 695G.310, inclusive, 695G.405 and 695G.415, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

(DeletedNRS by598.0977 amendment.)is Sec.hereby amended to read as follows:

598.0977 Except as otherwise provided in NRS 603A.550 [,] and section 18 of this act, if an elderly person or a person with a disability suffers damage or injury as a result of a deceptive trade practice, he or she or his or her legal representative, if any, may commence a civil action against any person who engaged in the practice to recover the actual damages suffered by the elderly person or person with a disability, punitive damages, if appropriate, and reasonable attorney’s fees.

The collection of any restitution awarded pursuant to this section has a priority over the collection of any civil penalty imposed pursuant to NRS 598.0973.

Sec.

The provisions of subsection 1 of NRS 218D.380 do not apply to any provision of this act which adds or revises a reqSec.requirement to submit a report to the Legislature.

Sec.

(DeletedThe byprovisions amendment.)heof Legislature.NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.

- *SB316_R1* – 35 – 3.

(a) Upon passage and approval for the purpose of adopting any regulations and performing any other preparatory administrativeadministrativey tasks that are necessary to carry out the provisions of this act;

H - *SB316_R2**SB316_R1*