Existing law establishes a process by which a person may request an exemption from a step therapy protocol established by his or her insurer for a prescription drug used to treat late stage cancer or an associated symptom. If such a request is granted, existing law requires the insurer to cover the prescription drug. (NRS 689A.04041, 689B.0305, 689C.1684, 695A.259, 695B.19085, 695C.17333, 695G.1675) Sections 1, 3-8 and 11 of this bill require certain private-sector insurers to establish a process by which an insured and his or her attending practitioner may: (1) request an exemption from a step therapy protocol that applies to prescription drugs; and (2) appeal a decision concerning such a request. Sections 1, 3-8 and 11 require an insurer to: (1) grant such a request if the attending practitioner submits certain information providing adequate justification for the exemption; and (2) make the process to request an exemption and submit an appeal accessible on an Internet website maintained by the insurer. Sections 1, 3-8 and 11 additionally require certain private-sector insurers to use guidelines based on medical or scientific evidence, if available, when developing a step therapy protocol. 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 a health maintenance organization that fails to comply with the requirements of section 8. The Commissioner is also authorized to take such action against other health insurers who fail to comply with the requirements of sections 1, 3-7 and 11. (NRS 680A.200) Sections 9 and 12 of this bill provide that the provisions of sections 8 and 11 do not apply to Medicaid managed care organizations. Sections 9 and 12 of this bill additionally provide that the provisions of sections 8 and 11, respectively, do not apply to a health maintenance organization or managed care organization that provides services to members of the Public Employees' Benefits Program.

Statutes affected:
As Introduced: 689A.330, 689C.425, 695C.050, 695C.330, 695G.090
Reprint 1: 689A.330, 689C.425, 695C.050, 695C.330, 695G.090
Reprint 2: 689A.330, 689C.425, 695C.050, 695C.330, 695G.090
As Enrolled: 689A.330, 689C.425, 695C.050, 695C.330, 695G.090
BDR: 689A.330, 689C.425, 695C.050, 695C.330, 695G.090