Existing law requires the Department of Health and Human Services to develop a list of preferred prescription drugs to be used for the Medicaid program. (NRS 422.4025) The policies of the Department currently provide for the coverage of any typical or atypical antipsychotic medication or anticonvulsant medication that is not on the list of preferred prescription drugs upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid. (Medicaid Services Manual 1203.1(B)(1)(h)) Section 1 of this bill codifies this requirement in law, and sections 2 and 4 of this bill clarify that the requirement applies to health maintenance organizations and other managed care organizations providing coverage to recipients of Medicaid. Section 3 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 requirement of section 2 to cover any typical or atypical antipsychotic medication or anticonvulsant medication that is not on the list of preferred prescription drugs upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid. The Commissioner would also be authorized to take such action against other managed care organizations who fail to comply with the requirements of section 4. (NRS 680A.200)

Statutes affected:
As Introduced: 422.4025, 695C.330
As Enrolled: 422.4025, 695C.330
BDR: 422.4025, 695C.330