Existing law requires certain public and private health plans, including the Public Employees' Benefits Program, to cover: (1) drugs that prevent the acquisition of human immunodeficiency virus or that treat human immunodeficiency virus or hepatitis C; (2) related laboratory and diagnostic procedures; and (3) certain other services to test for, prevent or treat human immunodeficiency virus or hepatitis C. (NRS 287.04335, 689A.0437, 689B.0312, 689C.1671, 695A.1843, 695B.1924, 695C.050, 695C.1743, 695G.1705) Existing law prohibits such health plans from implementing any medical management techniques on the coverage of such drugs or services, except the use of step therapy. (NRS 287.010, 287.04335, 689A.0437, 689B.0312, 689C.1671, 695A.1843, 695B.1924, 695C.050, 695C.1743, 695G.1705) Sections 1-7 of this bill remove the exemption for step therapy for private health plans, thereby prohibiting such health plans from requiring step therapy before providing coverage for a drug that: (1) prevents the acquisition of human immunodeficiency virus; or (2) treats human immunodeficiency virus or hepatitis C. Sections 6-8.5 of this bill authorize the Public Employees' Benefits Program and Medicaid managed care organizations to continue requiring the use of step therapy for coverage of such drugs as a medical management technique.

Statutes affected:
As Introduced: 689A.0437, 689B.0312, 689C.1671, 695A.1843, 695B.1924, 695C.1743, 695G.1705, 422.403
Reprint 1: 689A.0437, 689B.0312, 689C.1671, 695A.1843, 695B.1924, 695C.1743, 695G.1705, 287.04335
BDR: 689A.0437, 689B.0312, 689C.1671, 695A.1843, 695B.1924, 695C.1743, 695G.1705, 422.403