Section 16 of this bill requires a pharmacy benefit manager to disclose to a third party insurer for which the pharmacy benefit manager manages a pharmacy benefits plan:

calculateExisting anylaw cost-sharingestablishes obligationthe forbasis aupon prescriptionwhich druginsurance assessedadministrators, againstwhich ansinclude topharmacy insuredbenefit formanagers, themay prescriptionbe drug:compensated for their services.

(1)(NRS based683A.0883) onSection the16.5 netof pricethis thatbill theprohibits, thirdas partyof insurerJanuary or1, 2028, a pharmacy benefit managerservices withother whichthan income derived from administrative fees paid to the insurerpharmacynt hasbenefit contractedmanager paysby a third party insurer for the drug;provision of such services pursuant to an agreement that provides for such fees.

Existing law authorizes the Department of Health and (2)Human atServices to enter into a contract with a pharmacy benefit manager to manage coverage of prescription drugs under the point-of-sale.State Plan for Medicaid and the Children’s Health Insurance Program that requires the pharmacy benefit manager to provide to the Department all rebates received for purchasing drugs in relation to those programs.

Section(NRS 26422.4053) ofSection this[16] bill16.5 authorizesimposes thesimilar Commissionerrequirements tofor requirepharmacy abenefit domesticmanagers insurer that issuesmanage aother policypharmacy ofbenefits individualplans. health insurance to a person residing in another state to meet the requirements of section 25 in certain circumstances.

SectionsSpecifically, 33section and[16] 3716.5 ofrequires thisa billpharmacy indicatebenefit thatmanager theto requirementsprovide [the entire amount of sectionsany 32rebate andthe 36,pharmacy respectively,benefit aremanager inapplicablereceives] to::

(1) coverageincome providedgenerated bythrough discounts, fees and other incentives received from a managedmanufacturer careor organizationwholesaler toin recipientsconnection ofwith Medicaidproviding becausepharmacy existingbenefit providedmanagement byservices for a managedthird careparty organizationinsurer through rebates received from a manufacturer or wholesaler in connection withme generated providing pharmacy benefit management services for a third party insurer to memberspersons ofcovered by the Publicthird Employees’party Benefitsinsurer. Program.

Sections 25, 27-32, 35, 36, 40 and 41 of this bill require certain third party insurers that provide coverage for prescription drugs to [use any rebate money received from a pharmacy benefit manager pursuant to section 16 for the sole purpose of reducing premiums and eliminating or reducing cost-sharing obligations of covered persons.] include, when calculating the cost-sharing obligation or maximum out-of- pocket expense of an insured under certain circumstances, all amounts paid by the insured or another person on behalf of an insured towards the cost of a covered prescription drug.

Sections 25, 27-32, 35, 36 [,] and 40 [and 41] also prohibit third party insurers from imposing on an insured a cost-sharing obligation for a prescription drug which is greater than the net amount that the third party insurer pays for the drug.

Section 26 of this bill authorizes the Commissioner to require a domestic insurer that issues a policy of section 25 in certain circumstances.

Sections 33 and 37 of this bill indicate that theents of requirements of sections 32 and 36, respectively, are inapplicable to [a managed care organization that is providing] :

(1) coverage provided by a managed care organization to recipients of Medicaid because existing law imposes similar requirements of the Medicaid program [.] ;

and (2) coverage provided by a managed care organization to members of the Public Employees’ Benefits Program.

The Commissioner would also be authorizedSenate toAmendment takeNo. such action against other third party insurers who fail to comply with the requirements of sections 25, 27-32, 35 and 36.

190 to Senate Bill No.

316 Page 5 authorized to take such action against other third party insurers who fail to comply with the requirements of sections 25, 27-32, 35 and 36.

(1) unreasonably obstructing or interfering with the ability of a covered person to timely access a prescription drug at certain pharmacies;

and (4) making or disseminatingadditionally prohibits a falsepharmacy orbenefit misleadingmanager statementfrom orengaging advertisement.in certain practices while doing business with pharmacies.

Section 2419 of this bill additionallyrequires prohibits a pharmacy benefit manager fromto engagingsubmit into the Commissioner an annual report detailing certain business practices whileof doingthe businesspharmacy withbenefit pharmacies.manager as well as certain information regarding pricing and rebates relating to the prescription drugs administered by the pharmacy benefit manager.

Section 191 of this bill requires athird pharmacyparty benefitinsurers manager to submit toa thesimilar Commissioner an annual report detailingto certainthe businessCommissioner practicesrelating ofto the pharmacy benefit manager as well as certain information regarding pricing and rebates Section 1 of thisprescription billdrugs. requires third party insurers that provide coverage forr.

prescription drugs to submit a similar report to the Commissioner relating to the pricing of prescription drugs.

Sections 1 and 19 require the Commissioner to compile, submit to the Legislature and publish on the Internet - *SB316_R4* – 3 – biennial reports on the impact of the cost of prescription drugs on health insurance premiums in this State and the overall impact of pharmacy benefit managers on the cost of prescription drugs in this State, based on the reports submitted by third party insurers and pharmacy benefit managers, respectively.

Additionally,certain sectionconsumer 18complaints ofmade thisagainst billpharmacy requiresbenefit themanagers.publish Commissioner to publish on the Internet Existing law exempts certain consumerfederally complaintsregulated madeinsurance againstcoverage of prescription drugs provided by employers for their employees from requirements governing pharmacy benefit managers.managers except where the pharmacy benefit manager is required by contract to comply with those requirements.

Existing law exempts certain federally regulated insurance coverage of governing pharmacy benefit managers except where the pharmacy benefit managers is required by contract to comply with those requirements.

Additionally, sections 21.5 and 22 of this bill exempt coverage of prescription drugs provided by the Public Employees’ Benefits Program,Program insurance plans for local government employees and Medicaid managed care managers.ionsorganizations from the requirements of this bill governing pharmacy benefit Existingmanagers. law provides that a pharmacy benefit manager has an obligation of good faith and fair dealing toward a third party insurer or pharmacy when performing duties pursuant to a contract to which the pharmacy benefit manager is a party.

(NRSExisting 683A.178)law Sectionprovides 23that a pharmacy benefit manager has an obligation of good faith and fair dealing toward a third party insurer or pharmacy when performing duties pursuant to this bill provides that a pharmacy benefit manager also has [an obligation to act with care, skill, prudence, diligence and professionalism towards] a fiduciary duty to persons covered by a third party insurer [when providing] for which the pharmacy benefit manager provides pharmacy benefit services.services .

Section[pursuant mayto interferea contract with the duties and obligations of the pharmacy benefit managery that towards third party insurers,insurer.] pharmaciesSection and23 coveredalso: persons;

(1) prohibits a pharmacy benefit manager from engaging in an activity that may interfere with the duties and obligations of the pharmacy benefit manager towards third party insurers, pharmacies and covered persons;

Additionally,Existing anylaw violationdefines ofvarious sectionsactivities 3-24involving wouldbusinesses and occupations that deceptive trade practice, the person may be subject to a misdemeanor.civil action brought by certain persons and certain civil and criminal penalties.

(NRIf(NRS enacted,598.0999) Section 18 makes certain violations of sections 13-1515 and 24 a deceptive trade practice, thereby subjecting a violation of Assemblythose Billprovisions No.to additional penalties.

343However, (A.B.sections 18, 38 and 42 of this bill provide that such violations do not give rise to a private right of action.

343)Senate ofAmendment thisNo. session will require a hospital to publish certain information about its prices.

Section190 17to ofSenate A.B.Bill No.

343316 prohibitsPage a6 hospitalTHE fromPEOPLE takingOF certainTHE actionSTATE toOF collectNEVADA, medicalREPRESENTED debtIN whileSENATE theAND hospitalASSEMBLY, isDO notENACT inAS complianceFOLLOWS: with those requirements or certain similar federal requirements.

(45Section C.F.R.1.

§§ 180.40, 180.50, 180.60) Section 41.5 of this bill narrows the applicability of that prohibition to only apply to certain medical debt to which the failure to publish accurate pricing information is directly relevant.

Section 41.7 of this bill makes a conforming change to A.B.

343 to reflect the revisions made by section 41.5.

THE SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:D IN Section 1.

On or before [April] June 1 of each year, a health insurer that provides coverage for prescription drugs shall compile and submit - *SB316_R4* – 4 – to the Commissioner a report which contains the following information:

(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(4) The aggregate amount paid or reimbursed by a pharmacy benefit manager under contract with the insurer to insuredsaffiliated pharmacies in this State;State for the drug;

(4) The aggregate amount paid or reimbursed by a pharmacy benefit manager under contract with the insurer to affiliated pharmacies in this State for the drug;

- *SB316_R4* – 5 – (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.

3.Senate Amendment No.

190 to Senate Bill No.

316 Page 7 3.

§ 1396r-8(k)(5).1396r- 8(k)(5).

- *SB316_R4* – 6 – Sec.

and 2.Senate Amendment No.

190 to Senate Bill No.

316 Page 8 2.

- *SB316_R4* – 7 – (d) Processing requests for prior authorization for prescriptions;

(b) [Except as authorized by subsection 2, induce,] Induce, persuade or attempt to induce or persuade a covered person to transfer a prescription to or otherwise use an affiliated pharmacy instead of a nonaffiliated pharmacy in the applicable network;

- *SB316_R4* – 8 – (e) Discriminate against a nonaffiliated pharmacy based on the nonaffiliated status of the pharmacy, including, without limitation, by:

(1)Senate OfferingAmendment materiallyNo. different terms or conditions to a nonaffiliated pharmacy based on the status as a nonaffiliated pharmacy;

190 to Senate Bill No.

316 Page 9 (1) Offering materially different terms or conditions to a nonaffiliated pharmacy based on the status as a nonaffiliated pharmacy;

As[A usedthird inparty thisor section,pharmacy “network”benefit meansmanager amay definedreduce setthe amount of pharmaciesan thatapplicable arecost-sharing underobligation contractof toa providecovered person who fills a prescription or obtains other pharmacist services pursuantat to a networkparticular plan.pharmacy.

The third party or pharmacy benefit manager must reduce the cost-sharing obligation to an amount that is less than the cost-sharing obligation that the covered person would otherwise pay to fill the same prescription or obtain the same pharmacist services at any other pharmacy in the network under the terms of the applicable pharmacy benefits plan.

3.] As used in this section, “network” means a defined set of pharmacies that are under contract to provide pharmacist services pursuant to a network plan.

Shall[Except makeas availableotherwise forprovided inspectionin byNRS the422.4053, Commissioner,shall upontransmit requestthe ofentire theamount Commissioner,of any contractrebate betweenreceived thefrom a manufacturer or wholesaler in connection with providing pharmacy benefit managermanagement andservices for a pharmacythird orparty ato the third party.party to which the rebate pertains.

3.3.] Shall make available for inspection by the Commissioner, upon request of the Commissioner, any contract between the pharmacy benefit manager and a pharmacy or a third party.

[4.] 3.

(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:

Senate Amendment No.

190 to Senate Bill No.

316 Page 10 (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_R4* – 9 – (a) Unreasonably obstruct or interfere with the ability of a covered person to timely access a prescription drug or device that has been prescribed to the covered person at a contract pharmacy of the person’s choice.

TheExcept remediesas andotherwise penaltiesprovided set forth in this subsection, a violation of paragraph (l) of subsection 1 of NRS 683A.179 or section are15 notof exclusivethis andact areconstitutes ina additiondeceptive totrade anypractice otherfor remediesthe andpurposes penaltiesof providedNRS by598.0903 law.to 598.0999, inclusive.

This subsection does not create a private right of action.

The Attorney General may:

(a) Conduct an investigation to determine whether a pharmacy benefit manager, either directly or indirectly, has violated [,] or is violating [or is about to violate] the provisions of NRS 683A.171 to 683A.179, inclusive, and sections 3 to 19, inclusive, of this act, or any regulations adopted thereto.

(b) If he or she believes that a pharmacy benefit manager, either directly or indirectly, is violating or is about to violate the provisions of NRS 683A.171 to 683A.179, inclusive, and sections 3 to 19, inclusive, of this act, seek an injunction or other equitable relief to halt or prevent such a violation.

4.

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.

(b) Publish on an Internet website maintained by the Commissioner each complaint against a pharmacy benefit manager received pursuant to paragraph (a) which is determined by the Commissioner to be justified based on a determination by a preponderance of the evidence that the pharmacy benefit managerSenate violatedAmendment theNo. provisions of NRS 683A.171 to 683A.179, inclusive, and sections 3 to 19, inclusive, of this act.

190 to Senate Bill No.

316 Page 11 manager violated the provisions of NRS 683A.171 to 683A.179, inclusive, and sections 3 to 19, inclusive, of this act.

- *SB316_R4* – 10 – 2.

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

(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.

(IV) The amount of any rebate described in sub-sub-subparagraph subparagraph (III) that was passed on to either the applicable third party or the covered person;

- *SB316_R4* – 11 – (2) Amount of rebates negotiated for the purchase of the drug in this State;

(e)Senate AAmendment listNo. of the third parties with which the pharmacy benefit manager has contracted, the scope of services provided to each third party and the number of persons covered in this State by each third party listed.

190 to Senate Bill No.

316 Page 12 (e) A list of the third parties with which the pharmacy benefit manager has contracted, the scope of services provided to each third party and the number of persons covered in this State by each third party listed.

The data in the report compiled pursuant to this subsection must be in aggregated form and must not reveal information - *SB316_R4* – 12 – specifically concerning an individual purchaser or manufacturer of a drug, including, without limitation, information relating to a manufacturer’s individual or aggregate discounted prices for a prescription drug.

(c) “Wholesale acquisition cost” means the manufacturer’s published list price for a prescription drug with a unique National Drug Code for sale to a wholesalerSenate orAmendment anyNo. other purchaser or entity that purchases the prescription drug from the manufacturer, not including any rebates or other price concessions.

190 to Senate Bill No.

316 Page 13 wholesaler or any other purchaser or entity that purchases the prescription drug from the manufacturer, not including any rebates or other price concessions.

- *SB316_R4* – 13 – 2.

[AA participating[participating public agency, as that term is defined in NRS 287.04052, and any otherother] 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;

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.

The requirements of NRS 683A.171 to 683A.179, inclusive, and sections 3 to 19, inclusive, of this actact, do not apply to the coverage of prescription drugs provided by a managed care organization for:

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 - *SB316_R4* – 14 – district, municipal corporation, political subdivision, public corporation or other local governmental agency of this State.

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.

[Any(a) provisionOf] ofgood afaith contractand thatfair waivesdealing toward a third party or limitspharmacy thatwhen obligationperforming isduties againstpursuant publicto policy,a voidcontract andto unenforceable.]which 2.the pharmacy benefit manager is Senate Amendment No.

If190 theto dutiesSenate establishedBill inNo. 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.

3.316 Page 14 a party.

[Any provision of a contract that waives or limits that obligation is against public policy, void and unenforceable.

(b) To act with care, skill, prudence, diligence and professionalism towards persons covered by a third party when providing pharmacy benefit management services when performing duties pursuant to a contract between the pharmacy benefit manager and the third party.] 2.

[3.]3. 4.

5.4.

6.5.

- *SB316_R4* – 15 – Sec.

(g)Senate DirectlyAmendment orNo. indirectly reduce or allow the reduction of any payment to a pharmacy under a pharmacy benefits plan managed by the pharmacy benefit manager under a reconciliation process to an effective rate of reimbursement;

190 to Senate Bill No.

316 Page 15 (g) Directly or indirectly reduce or allow the reduction of any payment to a pharmacy under a pharmacy benefits plan managed by the pharmacy benefit manager under a reconciliation process to an effective rate of reimbursement;

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

- *SB316_R4* – 16 – (j) Charge a pharmacy or a pharmacist a fee to process a claim electronically;

An insurer that offers or issues a policy of health insurance which provides coverage for prescription drugs shall[shall] calculate: any cost-sharing obligation imposed against an insured for a prescription drug based on 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.

Senate Amendment No.

190 to Senate Bill No.

316 Page 16 [2.

An insurer that uses a pharmacy benefit manager to manage coverage of prescription drugs included in a policy of health insurance shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of insureds.] (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) *SB316_R4*“Amounts –paid” 17includes, –without (a)limitation, “Cost-sharinga obligation”discount, hasincentive, thecoupon meaningor ascribedother 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)[(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.683A.174.] (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of 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 drugs shall[shall] calculate: any cost-sharing obligation imposed against an insured for a prescription drug based on 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.

[2.

An insurer that uses a pharmacy benefit manager to manage coverage of prescription drugs included in a policy of group health insurance shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of insureds.] (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 Senate Amendment No.

190 to Senate Bill No.

316 Page 17 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)[(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.683A.174.] (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of 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 drugs shall[shall] calculate: any cost- sharing obligation imposed against an insured for a prescription drug based on the net price paid for the drug.

Any(a) suchShall cost-not sharingimpose 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.

[2.

A carrier that uses a pharmacy benefit manager to manage coverage of prescription drugs included in a health benefit plan shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of insureds.] (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 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.

-Senate *SB316_R4*Amendment –No. 18 – (a) “Cost-sharing obligation” has the meaning ascribed to it in section 6 of this act.

(b)190 “Netto priceSenate paid”Bill meansNo. the price paid for a prescription drug by a carrier or a pharmacy benefit manager with which a carrier has contracted, inclusive of any rebates received for the prescription drug.

(c)316 “PharmacyPage benefit18 manager”(a) has“Amounts paid” includes, without limitation, a discount, incentive, coupon or other assistance provided to an insured by a manufacturer or wholesaler of a prescription drug which is meant to reduce the meaningout-of-pocket ascribedcost that the insured is required to itpay infor NRSa 683A.174.prescription drug at the point of sale.

(d)(b) “Rebate”“Cost-sharing obligation” has the meaning ascribed to it in section 136 of this act.

[(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.] (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of the same strength, quantity and form of dosage as a drug with a brand name.

A society that offers or issues a benefit contract which provides coverage for prescription drugs shall[shall] calculate: any cost- sharing obligation imposed against an insured for a prescription drug based on the net price paid for the drug.

Any(a) suchShall cost-not sharingimpose 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.

[2.

A society that uses a pharmacy benefit manager to manage coverage of prescription drugs included in a benefit contract shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of insureds.] (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 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)[(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.683A.174.] Senate Amendment No.

(d)190 “Rebate” has the meaning ascribed to itSenate inBill sectionNo. 13 of this act.

316 Page 19 (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of the same strength, quantity and form of dosage as a drug with a brand name.

A hospital or medical services corporation that offers or issues a policy of health insurance which provides coverage for prescription drugs shall[shall] calculate: any cost-sharing obligation imposed against an insured for a prescription drug based on 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.

[2.

A hospital or medical services corporation that uses a pharmacy benefit manager to manage coverage of prescription drugs included in a policy of health insurance shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of insureds.] (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;

(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) *SB316_R4*“Amounts –paid” 19includes, –without (a)limitation, “Cost-sharinga obligation”discount, hasincentive, thecoupon meaningor ascribedother 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)[(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.683A.174.] (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of 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 drugs shall[shall] calculate: any cost-sharing obligation imposed against an enrollee for a prescription drug based on 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.

Senate Amendment No.

190 to Senate Bill No.

316 Page 20 [2.

A health maintenance organization that uses a pharmacy benefit manager to manage coverage of prescription drugs included in a health care plan shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of enrollees.] (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 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)[(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.683A.174.] (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of 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.

- *SB316_R4* – 20 – 3.

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 through managedSenate careAmendment toNo. 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.

190 to Senate Bill No.

316 Page 21 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.

(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, - *SB316_R4* – 21 – 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;

(1)Senate ResolvingAmendment complaintsNo. in a manner reasonably to dispose of valid complaints;

190 to Senate Bill No.

316 Page 22 (1) Resolving complaints in a manner reasonably to dispose of valid complaints;

- *SB316_R4* – 22 – 3.

A prepaid limited health service organization that provides coverage for prescription drugs shall[shall] calculate: any cost-sharing obligation imposed against an enrollee for a prescription drug based on 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.

[2.

A prepaid limited health service organization that uses a pharmacy benefit manager to manage coverage of prescription drugs included in evidence of coverage shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of enrollees.] (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 Senate Amendment No.

190 to Senate Bill No.

316 Page 23 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)[(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.683A.174.] (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of 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 drugs shall[shall] calculate: any cost-sharing obligation imposed against an insured for a prescription drug based on 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 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.

[2.

A managed care organization that uses a pharmacy benefit manager to manage coverage of prescription drugs included in a health care plan shall use any money received from the pharmacy benefit manager pursuant to section 16 of this act for the sole purpose of reducing premiums and offsetting or reducing cost-sharing obligations of insureds.] (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) *SB316_R4*“Amounts –paid” 23includes, –without (a)limitation, “Cost-sharinga obligation”discount, hasincentive, thecoupon meaningor ascribedother 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)Senate “PharmacyAmendment benefitNo. manager” has the meaning ascribed to it in NRS 683A.174.

(d)190 “Rebate” has the meaning ascribed to itSenate inBill sectionNo. 13 of this act.

316 Page 24 [(b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.] (c) “Generic equivalent” means a prescription drug that is biologically equivalent and has the same active ingredient or ingredients of the same strength, quantity and form of dosage as a drug with a brand name.

(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, 62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, - *SB316_R4* – 24 – 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,Senate 119.260,Amendment 119.265,No. 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, 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, 439.4941, 439.4988, 439.5282, 439.840, 439.914, 439A.116, - *SB316_R4* – 25 – 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, 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 confidential, all public books and public records of a governmental - *SB316_R4* – 26 – 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.

190 to Senate Bill No.

316 Page 25 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, 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, 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, 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, Senate Amendment No.

190 to Senate Bill No.

316 Page 26 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 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.

(a)Senate ShallAmendment notNo. refuse to provide a copy of that public record in the medium that is requested because the officer, employee or agent has already prepared or would prefer to provide the copy in a different medium.

190 to Senate Bill No.

316 Page 27 (a) Shall not refuse to provide a copy of that public record in the medium that is requested because the officer, employee or agent has already prepared or would prefer to provide the copy in a different medium.

- *SB316_R4* – 27 – Sec.

40.

(Deleted by amendment.) Sec.

41.

NRS 287.04335 is hereby amended to read as follows:

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 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 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.

41.5.40.

SectionNRS 17287.010 ofis Assemblyhereby Billamended No.to read as follows:

343287.010 of1. this session is hereby amended to read as follows:

Sec.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:

17.(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.

1.(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.

A(c) hospitalProvide shallgroup notlife, takeaccident anyor actionhealth describedcoverage inthrough subsectiona 2self-insurance withreserve regardfund toand, coveredwhere medicalnecessary, debtdeduct incurredcontributions byto athe medicalmaintenance debtorof while the hospitalfund isfrom notthe incompensation compliance with any provision of sectionofficers 13,and 14employees orand 15pay ofthe thisdeductions actinto orthe 45fund. C.F.R.

§The 180.40,money 180.50accumulated orfor 180.60.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 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.

AIf hospitala shallschool not,district withoffers regardgroup insurance to anyits coveredofficers medicaland debtemployees describedpursuant to this section, members of the board of trustees of the school district must not be excluded from participating in subsectionthe 1:group insurance.

(a)If Referthe amount of the covereddeductions medicalfrom debtcompensation required to apay collectionfor agencythe orgroup otherinsurance thirdexceeds partythe forSenate collection;Amendment No.

(b)190 File a civil action or seek arbitration or mediation to collectSenate theBill coveredNo. medical debt;

or316 (c)Page Directly28 orcompensation indirectlyto causewhich thea reportingtrustee ofis entitled, the covereddifference medicalmust debtbe topaid aby reportingthe agency.trustee.

IfIn aany medicalcounty debtorin believeswhich that a hospitallegal hasservices takenorganization anexists, actionthe describedgoverning inbody subsectionof 2the incounty, violationor of subsectionany 1school withdistrict, respectmunicipal tocorporation, anypolitical coveredsubdivision, medicalpublic debtcorporation owedor byother thelocal medicalgovernmental debtor,agency of the medicalState debtorof Nevada in the county, may fileenter into a claimcontract with the Bureaulegal services organization pursuant to which the officers and employees of Consumerthe Protectionlegal inservices organization, and the Officedependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the Attorneyofficers General.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.

A medical debtor who files such a claim shall immediately notify the hospital that he or she has filed the claim.

UponIf thea filingcontract ofis aentered claiminto pursuant to subsection 3, the Bureauofficers ofand Consumeremployees Protectionof shallthe investigatelegal theservices claim.organization:

The(a) hospitalShall shallbe notdeemed, takesolely anyfor actionthe describedpurposes inof subsectionthis 2section, to collectbe officers and employees of the coveredcounty, medicalschool debtdistrict, thatmunicipal iscorporation, thepolitical subjectsubdivision, ofpublic thecorporation investigationor whileother local governmental agency with which the investigationlegal isservices pending.organization has contracted;

-and *SB316_R4*(b) –Must 28be –required 5.by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which they authorize the purchase.

If,5. at the conclusion of an investigation pursuant to subsection 4, the Bureau of Consumer Protection determines that the hospital has taken an action described in subsection 2 in violation of subsection 1, the hospital shall cancel the covered medical debt that is the subject of the investigation and any related medical debt and refund any amount of the covered medical debt or any related medical debt which has been paid by the medical debtor.

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.

AAs knowingused violationin of this sectionsection, constitutes“legal aservices deceptiveorganization” trademeans practicean organization that operates a program for thelegal purposesaid ofand NRSreceives 598.0903money pursuant to 598.0999,NRS inclusive.19.031.

7.

As used in this section:

(a) “Covered bill or group of bills” means a bill or group of bills that includes any charge for a medical service, product or device which is greater than the amount published for that medical service, product or device pursuant to section 13, 14 or 15 of this act or 45 C.F.R.

§ 180.40, 180.50 or 180.60, as applicable.

(b) “Covered medical debt” means medical debt owed by a medical debtor which was originally included in a covered bill or group of bills issued to the medical debtor.

(c) “Reporting agency” has the meaning ascribed to it in NRS 598C.100.

41.7.41.

SectionNRS 26287.04335 ofis Assemblyhereby Billamended No.to read as follows:

343287.04335 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 695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, inclusive, other than section 36 of this sessionact, 695G.241 to 695G.310, inclusive, 695G.405 and 695G.415, [and section 36 of this act,] in the same manner as an insurer that is herebylicensed amendedpursuant to readtitle as57 follows:of NRS is required to comply with those provisions.

26.

1.

The provisions of section 17 of this act apply to any covered medical debt incurred before, on or after January 1, 2026.

2.

The provisions of section 22 of this act apply to any medical debt incurred on or after January 1, 2026.

3.

As used in this section [, “medical] :

(a) “Covered medical debt” has the meaning ascribed to it in section 17 of Assembly Bill No.

343 of this session, as amended by section 41.5 of this act.

(b) “Medical debt” has the meaning ascribed to it in [NRS 649.036.] section 7 of Assembly Bill No.

343 of this session.

Sec.

(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.

Sec.Senate Amendment No.

190 to Senate Bill No.

316 Page 29 Sec.

(DeletedThe byprovisions amendment.)of -NRS *SB316_R4*354.599 –do 29not –apply Sec.to any additional expenses of a local government that are related to the provisions of this act.

Sec.

Sections 1 to 16, inclusive, and 17 to 24, inclusive, 38, 39, 40 and 42 to 45, inclusive, of this act become effective:

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

SectionsSection 41.516.5 and 41.7 of this act becomebecomes effective:

and (b) On January 1, 2026, for all other purposes,  if and only if Assembly Bill No.

343 of this session is enacted by the Legislature and approved by the Governor.

4.

Sections 16.5, 25 to 37, inclusive, and 41 of this act become effective:

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

H - *SB316_R4*