Existing law prohibits a policy of health insurance which provides coverage for prescription drugs, including a policy of health insurance provided by a local government or private employer for its employees, from limiting or excluding coverage for a drug if the drug: (1) had previously been approved for coverage by the insurer for a medical condition of an insured and the insured's provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured; and (2) is appropriately prescribed and considered safe and effective for treating the medical condition of the insured. (NRS 689A.04045, 689B.0368, 689C.168, 695A.184, 695B.1905, 695C.1734, 695F.156, 695G.166) Existing law also requires the Department of Health and Human Services to establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs. (NRS 422.403) Sections 1, 3-9 and 11-15 of this bill prohibit private insurers, voluntary purchasing groups, insurance plans for state, local and private employees and Medicaid from imposing a step therapy protocol for a drug that is approved by the United States Food and Drug Administration or that medical or scientific evidence establishes may be used to treat a psychiatric condition if: (1) a practitioner who meets certain requirements prescribed the drug; and (2) that practitioner reasonably expects each drug that is required to be dispensed according to the step therapy protocol to be ineffective. Section 2 of this bill makes a conforming change to indicate the proper placement of section 1 in the Nevada Revised Statutes. Section 10 of this bill authorizes the Commissioner of Insurance to suspend or revoke the certificate of authority of a health maintenance organization that fails to comply with the requirements of section 8 of this bill. The Commissioner would also be authorized to take such action against other health insurers who fail to comply with the requirements of sections 1, 3-8, 11 and 12 of this bill. (NRS 680A.200)

Statutes affected:
As Introduced: 689A.330, 689C.425, 695C.050, 695C.330, 287.010, 287.04335, 422.403
Reprint 1: 689A.330, 689C.425, 695C.050, 695C.330, 287.010, 287.04335, 422.403
As Enrolled: 689A.330, 689C.425, 695C.050, 695C.330, 287.010, 287.04335, 422.403
BDR: 689A.330, 689C.425, 695C.050, 695C.330, 287.010, 287.04335, 422.403