Revises provisions governing pharmacists. (BDR 54-344)

EXEMPT
(Reprinted with amendments adopted on April 21, 2025)
FIRST REPRINT A.B. 186

- *AB186_R1*

ASSEMBLY BILL NO. 186–ASSEMBLYMEMBER ORENTLICHER

PREFILED FEBRUARY 3, 2025
____________

Referred to Committee on Commerce and Labor

SUMMARY—Revises provisions governing pharmacists.
(BDR 54-344)

FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.

~

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

AN ACT relating to pharmacy; authorizing a registered pharmacist
to prescribe drugs and devices to treat certain health
conditions and dispense a refill without the authorization
of a practitioner, other than a pharmacist, under certain
circumstances; authorizing a registered pharmacist to
administer drugs; authorizing a registered pharmacist to
engage in certain activity relating to laboratories and
laboratory testing; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing law authorizes, under certain condit ions, a pharmacist to dispense a 1
self-administered hormonal contraceptive without a prescription and prescribe and 2
dispense a drug for the medication -assisted treatment of opioid use disorder. (NRS 3
639.28078, 639.28079) Section 1 of this bill authorizes a registered pharmacist to 4
prescribe and dispense drugs and devices for the treatment of health conditions that: 5
(1) have been previously diagnosed; (2) are self-limiting; or (3) are acute conditions 6
diagnosed after the performance of certain tests. Section 1 additionally authorizes a 7
registered pharmacist to dispense a one -time refill of a prescription without the 8
authorization of a practitioner, other than a pharmacist, if the drug was previously 9
prescribed to the patient and losing access to the drug would threaten the health of 10
the patient. Section 1 additionally prohibits a registered pharmacist from taking 11
such action with regard to: (1) drugs and devices not approved by the United States 12
Food and Drug Administration ; (2) controlled substances that are n ot opioids, 13
except in certain clinical settings; and (3) controlled substances that are an opioid 14
except in accordance with the protocols for prescribing and dispensing a drug for 15
medication-assisted treatment. (NRS 639.28079) Section 1 also authorizes the State 16
Board of Pharmacy to adopt regulations establishing: (1) the scope of the ability of 17
a registered pharmacist to prescribe drugs and devices and dispense refills without 18
the authorization of another type of practitioner; (2) the standard of care required of 19

– 2 –

- *AB186_R1*
a registered pharmacist who engages in such activities; and (3) the requirements for 20
adequate liability insurance for registered pharmacists who engage in such 21
activities. Section 2 of this bill provides that prescribing and dispensing drugs and 22
devices and dispensing refills pursuant to section 1 constitutes the practice of 23
pharmacy. Sections 3, 10-13 and 15 of this bill make additional changes necessary 24
to authorize a registered pharmacist to prescribe and dispense drugs and devices 25
and dispense r efills without the authorization of another type of practitioner 26
pursuant to section 1. The Board would be authorized to suspend or revoke the 27
registration of a pharmacist who prescribes or dispenses a drug or device or 28
dispenses a refill without the authorization of another type of practitioner and fails 29
to comply with the provisions of section 1 or the regulations adopted pursuant 30
thereto. (NRS 639.210) 31
Existing law includes within the practice of pharmacy the performance or 32
supervision of activities ass ociated with manufacturing, compounding, labeling, 33
dispensing and distributing a drug. (NRS 629.0124) Section 2 additionally includes 34
the performance or supervision of activities associated with administering a drug, 35
thereby authorizing a registered pharma cist to perform or supervise such activities. 36
Sections 14, 16 and 17 of this bill accordingly provide general authorization for a 37
registered pharmacist to possess and administer controlled substances and 38
dangerous drugs. 39
Existing law requires the Board t o adopt regulations governing the 40
manipulation of a person for the collection of specimens by a registered pharmacist 41
that: (1) require the pharmacist to use only a fingerstick or oral or nasal swab to 42
collect the specimens; and (2) set forth the procedure s and requirements the 43
pharmacist is required to follow when manipulating a person for the collection of a 44
specimen. (NRS 639.0747) Section 4 of this bill removes the requirement that a 45
pharmacist use only a fingerstick or oral or nasal swab to collect a s pecimen, 46
thereby authorizing a pharmacist to collect a specimen using any method available 47
for the collection of the specimen. 48
Existing law authorizes a registered pharmacist or a registered intern 49
pharmacist to: (1) perform a home blood glucose test; an d (2) order and perform 50
laboratory tests that are necessary for therapy that uses a drug approved by the 51
United States Food and Drug Administration for preventing the acquisition of 52
human immunodeficiency virus. (NRS 639.2808, 639.28085) Section 5 of this bill 53
additionally authorizes a registered pharmacist to: (1) order laboratory tests that are 54
necessary for any drug therapy or that otherwise facilitate the care of a patient 55
within the authorized scope of practice of the pharmacist; and (2) perform certai n 56
other laboratory tests determined by the Federal Government to be simple 57
laboratory examinations and procedures that have an insignificant risk of an 58
erroneous result. (42 U.S.C. 263a(d)(3); 42 C.F.R. Part 493, Subpart A) Section 5 59
also authorizes the St ate Board of Pharmacy to adopt regulations to authorize 60
registered intern pharmacists to order and perform such laboratory tests. Section 2 61
provides that ordering and performing such laboratory tests constitutes the practice 62
of pharmacy. Sections 2 and 6 of this bill remove duplicative provisions from 63
existing law. Sections 8, 9 and 18-24 of this bill make conforming changes so that 64
requirements for insurance coverage of certain services performed by registered 65
pharmacists are not changed by this bill. 66
Existing law requires the State Board of Health to adopt regulations for the 67
certification and licensure of laboratory directors. (NRS 652.125) Existing 68
regulations define an exempt laboratory to be a laboratory that: (1) conducts only 69
certain microscopy te sts and tests determined by the Federal Government to be 70
simple laboratory examinations and procedures that have an insignificant risk of an 71
erroneous result; and (2) does not perform only tests for human immunodeficiency 72
virus. (42 U.S.C. 493.19; 42 C.F.R. Part 493, Subpart A; NAC 652.072) Section 7 73

– 3 –

- *AB186_R1*
of this bill requires regulations of the Board to authorize a registered pharmacist to 74
serve as the laboratory director of an exempt laboratory. 75

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. Chapter 639 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. Subject to the limitations set forth in subsection 2, a 3
registered pharmacist may, in accordance with any requirements 4
prescribed pursuant to subsection 3: 5
(a) Prescribe drugs or devices that are used for the treatment 6
of health conditions, other than opioid use disorder, that: 7
(1) Have been previously diagnosed; 8
(2) Are self-limiting; or 9
(3) Are acute conditions diagnosed after performing a test 10
that is classified as a waived test pursuant to 42 C.F.R. Part 493, 11
Subpart A; and 12
(b) Dispense a one -time refill of an existing prescription 13
without authorization from a practitioner, other than a 14
pharmacist, if, in the professional judgment of the pharmacist, the 15
health of the patient will be harmed without the patient continuing 16
to have access to the prescribed drug. 17
2. A registered pharmacist shall not take any action described 18
in subsection 1 with regard to a: 19
(a) Drug or device that is not approved by the United States 20
Food and Drug Administration. 21
(b) Controlled substance that is not an opioid, except if the 22
registered pharmacist is prescribing such a controlled substance 23
in: 24
(1) An inpatient medical facility in accordance with the 25
policies of the facility; 26
(2) An outpatient medical facility or clinic , only if the 27
registered pharmacist is acting within a multidisciplinary team; 28
(3) A program for hospice care or palliative care; or 29
(4) A program for treatment for substance use disorder. 30
(c) Controlled substance that is an opioid. 31
3. The Board may adopt regulations: 32
(a) Requiring a registered pharmacist who takes the actions 33
authorized by this section to be covered by adequate liability 34
insurance, as determined by the Board; 35
(b) Establishing the scope of the ability for a registered 36
pharmacist to prescribe drugs and devices and dispense refills as 37
authorized by subsection 1; and 38

– 4 –

- *AB186_R1*
(c) Establishing the standard of care required of a registered 1
pharmacist who prescribes drugs and devices and dispenses refills 2
as authorized by subsection 1. 3
4. As used in this section: 4
(a) “Medical facility” has the meaning ascribed to it in 5
NRS 449.0151. 6
(b) “Program of hospice care” means a program of hospice 7
care described in NRS 449.196. 8
(c) “Self-limiting” means that a health condition generally 9
persists for a limited period of time. 10
Sec. 2. NRS 639.0124 is hereby amended to read as follows: 11
639.0124 1. “Practice of pharmacy” includes, but is not 12
limited to, the: 13
(a) Performance or supervision of activities associated with 14
manufacturing, compounding, labeling, dispensing , [and] 15
distributing [of] and administering a drug, including the receipt, 16
handling and storage of prescriptions and other confidential 17
information relating to patients. 18
(b) Interpretation and evaluation of prescriptions or orders for 19
medicine. 20
(c) Participation in drug evaluation and drug research. 21
(d) Advising of the therapeutic value, reaction, drug interaction, 22
hazard and use of a drug. 23
(e) Selection of the source, storage and distribution of a drug. 24
(f) Maintenance of proper documentation of the source, storage 25
and distribution of a drug. 26
(g) Interpretation of clinical data contained in a pe rson’s record 27
of medication. 28
(h) Development of written guidelines and protocols in 29
collaboration with a practitioner which authorize collaborative drug 30
therapy management. The written guidelines and protocols must 31
comply with NRS 639.2629. 32
(i) Implementation and modification of drug therapy, 33
administering drugs and ordering and performing tests in 34
accordance with a collaborative practice agreement. 35
(j) Prescribing, dispensing and administering of drugs for 36
preventing the acquisition of human immunodefic iency virus and 37
[ordering and] conducting laboratory tests necessary for therapy that 38
uses such drugs pursuant to the protocol prescribed pursuant to 39
NRS 639.28085. 40
(k) Dispensing a self -administered hormonal contraceptive 41
pursuant to NRS 639.28078. 42
(l) Assessing a patient and prescribing and dispensing a drug for 43
medication-assisted treatment in accordance with NRS 639.28079. 44

– 5 –

- *AB186_R1*
(m) Ordering and performing laboratory tests in accordance 1
with NRS 639.2808. 2
(n) Prescribing and dispensing drugs and devices and 3
dispensing refills without the authorization of a practitioner, other 4
than a pharmacist, in accordance with section 1 of this act. 5
2. The term does not include the changing of a prescription by 6
a pharmacist or practitioner without the consent of the prescribing 7
practitioner, except as otherwise provided in NRS 639.2583, 8
639.28078 and 639.28085. 9
Sec. 3. NRS 639.0125 is hereby amended to read as follows: 10
639.0125 “Practitioner” means: 11
1. A physician, dentist, veterinarian or podiatric physician who 12
holds a license to practice his or her profession in this State; 13
2. A hospital, pharmacy or other institution licensed, registered 14
or otherwise permitted to distribute, dispense, conduct research with 15
respect to or administer drugs in the course of professional practice 16
or research in this State; 17
3. An advanced practice registered nurse who has been 18
authorized to prescribe controlled substances, poisons, dangerous 19
drugs and devices; 20
4. A physician assistant who: 21
(a) Holds a license issued by the Board of Medical Examiners; 22
and 23
(b) Is authorized by the Board to possess, administer, prescribe 24
or dispense controlled substances, poisons, dangerous drugs or 25
devices under the supervision of a physician as required by chapter 26
630 of NRS; 27
5. A physician assistant who: 28
(a) Holds a license issued by the State Board of Osteopathic 29
Medicine; and 30
(b) Is authorized by the Board to possess, administer, prescribe 31
or dispense controlled substances, poisons, dangerous drugs o r 32
devices under the supervision of an osteopathic physician as 33
required by chapter 633 of NRS; 34
6. An optometrist who is certified by the Nevada State Board 35
of Optometry to prescribe and administer pharmaceutical agents 36
pursuant to NRS 636.288, when the o ptometrist prescribes or 37
administers pharmaceutical agents within the scope of his or her 38
certification; 39
7. A dental hygienist who: 40
(a) Holds a valid license to practice dental hygiene in this State; 41
(b) Is authorized to prescribe and dispense the dan gerous drugs 42
and devices listed in NRS 631.3105 in accordance with the 43
provisions of that section and the regulations adopted pursuant 44
thereto; and 45

– 6 –

- *AB186_R1*
(c) Holds a certificate issued pursuant to NRS 639.1374 by the 1
State Board of Pharmacy authorizing him or her to so prescribe; 2
8. A pharmacist who [is] : 3
(a) Is registered pursuant to NRS 639.28079 to prescribe and 4
dispense drugs for medication-assisted treatment; or 5
(b) Prescribes drugs or devices or dispenses refills without the 6
authorization of a practitioner, other than a pharmacist, in 7
accordance with section 1 of this act; or 8
9. A certified registered nurse anesthetist who orders, 9
prescribes, possesses or administers controlled substances, po isons, 10
dangerous drugs or devices in accordance with NRS 632.2397. 11
Sec. 4. NRS 639.0747 is hereby amended to read as follows: 12
639.0747 [1.] The Board shall adopt such regulations as are 13
necessary to carry out the provisions of NRS 652.210 with regard to 14
a registered pharmacist, including, without limitation, regulations 15
that [: 16
(a) Require a registered pharmacist to use only a fingerstick or 17
oral or nasal swab to collect the specimens pursuant to NRS 18
652.210; and 19
(b) Set] set forth the procedures and requirements with which a 20
registered pharmacist shall comply when manipulating a person for 21
the collection of specimens or performing any laboratory test 22
pursuant to NRS 652.210. 23
[2. As used in this section, “finger stick” means a procedure in 24
which a finger is pricked with a lancet, small blade or other 25
instrument to obtain a small quantity of blood for any laboratory test 26
pursuant to NRS 652.210.] 27
Sec. 5. NRS 639.2808 is hereby amended to read as follows: 28
639.2808 1. A registered pharmacist [or a] may: 29
(a) Order laboratory tests that are necessary for therapy that 30
uses a drug approved by the Food and Drug Administration or to 31
otherwise facilitate the care of a patient within the authorized 32
scope of practice of the registered pharmacist; and 33
(b) Perform any laboratory test that is classified as a waived 34
test under 42 C.F.R. Part 493, Subpart A, including, without 35
limitation, a blood glucose test using devices for monitoring 36
approved by the Food and Drug Administration for use in the 37
home if such a test is performed in compliance with standards of 38
practice recommended by the Association of Diabetes Care and 39
Education Specialists. 40
2. A registered intern pharmacist may perform a blood glucose 41
test using devices for monitoring approved by the Food and Drug 42
Administration for use in the home. The performance of such a test 43
must be in compliance with standards of practice recommended by 44
the [American] Association of Diabetes [Educators] Care and 45

– 7 –

- *AB186_R1*
Education Specialists or its successor organization. The Board may 1
adopt regulations authorizing a registered intern pharmacist to 2
perform other activities described in subsection 1. 3
Sec. 6. NRS 639.28085 is hereby amended to read as follows: 4
639.28085 1. To the extent authorized by federal law, a 5
pharmacist who meets the requirements prescribed by the Board 6
pursuant to subsection 2 may, in accordance with the requirements 7
of the protocol prescribed pursuant to subsection 2: 8
(a) [Order and perform ] Perform laboratory tests that are 9
necessary for therapy that uses a drug approved by the United States 10
Food and Drug Administration for preventing the acquisition of 11
human immunodeficiency virus; and 12
(b) Prescribe, dispense and administer any drug described in 13
paragraph (a) to a patient. 14
2. The Board shall adopt regulations: 15
(a) Requiring a pharmacist who takes the actions authorized by 16
this section to be covered by adequate liability insurance, as 17
determined by the Board; and 18
(b) Establishing a protocol for the actions authorized by this 19
section. 20
Sec. 7. NRS 652.125 is hereby amended to read as follows: 21
652.125 1. The Board shall adopt regulations for the 22
certification and licensure of laboratory directors and laboratory 23
personnel who perform technical duties other than the collection of 24
blood. The regulations must authorize a registered pharmacist to 25
serve as the laboratory director of an exempt laboratory, 26
regardless of whether the registered pharmacist has entered into a 27
collaborative practice agreement. 28
2. The Division shall, as a prerequisite for the renewal of a 29
certificate or license, require the laboratory director and any 30
laboratory personnel certified by the Division pursuant to this 31
chapter to comply with the r equirements for continuing education 32
adopted by the Board. 33
3. As used in this section: 34
(a) “Collaborative practice agreement” has the meaning 35
ascribed to it in NRS 639.0052. 36
(b) “Exempt laboratory” means a laboratory: 37
(1) That is licensed pursuant to this chapter and the 38
regulations adopted pursuant thereto; 39
(2) That does not only perform testing for human 40
immunodeficiency virus; and 41
(3) In which each test performed is: 42
(I) Classified as a waived test pursuant to 42 C.F.R. Part 43
493, Subpart A; or 44

– 8 –

- *AB186_R1*
(II) Categorized as a provider -performed microscopy 1
procedure pursuant to 42 C.F.R. § 493.19. 2
Sec. 8. NRS 287.0271 is hereby amended to read as follows: 3
287.0271 1. The governing body of any county, school 4
district, municipal corporation, political subdivision, public 5
corporation or other local governmental agency of the State of 6
Nevada that provides health insurance through a plan of self -7
insurance shall provide coverage for: 8
(a) Drugs approved by the United Sta tes Food and Drug 9
Administration for preventing the acquisition of human 10
immunodeficiency virus; 11
(b) Laboratory testing that is necessary for therapy that uses 12
such a drug; and 13
(c) [The] Ordering laboratory testing described in paragraph 14
(b) and the services described in NRS 639.28085, when provided by 15
a pharmacist who participates in the network plan of the governing 16
body. 17
2. The governing body of any county, school district, 18
municipal corporation, political subdivision, public corporation or 19
other local governmental agency of the State of Nevada that 20
provides health insurance through a plan of self -insurance shall 21
reimburse a pharmacist who participates in the network plan of the 22
governing body for the services described in [NRS 639.28085 ] 23
paragraph (c) of subsection 1 at a rate equal to the rate of 24
reimbursement provided to a physician, physician assistant or 25
advanced practice registered nurse for similar services. 26
3. The governing body of any county, school district, 27
municipal corporation, pol itical subdivision, public corporation or 28
other local governmental agency of the State of Nevada that 29
provides health insurance through a plan of self -insurance may 30
subject the benefits required by subsection 1 to reasonable medical 31
management techniques. 32
4. The governing body of any county, school district, 33
municipal corporation, political subdivision, public corporation or 34
other local governmental agency of the State of Nevada that 35
provides health insurance through a plan of self -insurance shall 36
ensure that the benefits required by subsection 1 are made available 37
to an insured through a provider of health care who participates in 38
the network plan of the governing body. 39
5. A plan of self -insurance described in subsection 1 that is 40
delivered, issued for delivery or renewed on or after January 1, 41
2024, has the legal effect of including the coverage required by 42
subsection 1, and any provision of the plan that conflicts with the 43
provisions of this section is void. 44
6. As used in this section: 45

– 9 –

- *AB186_R1*
(a) “Medical management technique” means a practice which is 1
used to control the cost or use of health care services or prescription 2
drugs. The term includes, without limitation, the use of step therapy, 3
prior authorization and categorizing drugs and devices based on 4
cost, type or method of administration. 5
(b) “Network plan” means a plan of self -insurance provided by 6
the governing body of a local governmental agency under which the 7
financing and delivery of medical care, including items and services 8
paid for as medical care, are provided, in whole or in part, through a 9
defined set of providers under contract with the governing body. 10
The term does not include an arrangement for the financing of 11
premiums. 12
(c) “Provider of health care” has the meaning ascribed to it in 13
NRS 629.031. 14
Sec. 9. NRS 422.27235 is hereby amended to read as follows: 15
422.27235 1. The Director shall include in the State Plan for 16
Medicaid a requirement that the State pay the nonfederal share of 17
expenditures incurred for: 18
(a) Any laboratory testing that is necessary for therapy that uses 19
a drug approved by the United States Food and Drug Administration 20
for preventing the acquisition of human immunodeficiency virus. 21
(b) The ordering of a laboratory test descr ibed in paragraph 22
(a) by a pharmacist and the services of a pharmacist described in 23
NRS 639.28085. The State must provide reimbursement for such 24
services at a rate equal to the rate of reimbursement provided to a 25
physician, physician assistant or advanced practice registered nurse 26
for similar services. 27
(c) Any service to test for, prevent or treat human 28
immunodeficiency virus or hepatitis C provided by a provider of 29
primary care if the service is covered when provided by a specialist 30
and: 31
(1) The service is within the scope of practice of the provider 32
of primary care; or 33
(2) The provider of primary care is capable of providing the 34
service safely and effectively in consultation with a specialist and 35
the provider engages in such consultation. 36
2. The Director shall include in the State Plan for Medicaid a 37
requirement that the State reimburse an advanced practice registered 38
nurse or a physician assistant for any service to test for, prevent or 39
treat human immunodeficiency virus or hepatitis C at a rate eq ual to 40
the rate of reimbursement provided to a physician for similar 41
services. 42
3. As used in this section, “primary care” means the practice of 43
family medicine, pediatrics, internal medicine, obstetrics and 44
gynecology and midwifery. 45

– 10 –

- *AB186_R1*
Sec. 10. NRS 453.126 is hereby amended to read as follows: 1
453.126 “Practitioner” means: 2
1. A physician, dentist, veterinarian or podiatric physician who 3
holds a license to practice his or her profession in this State and is 4
registered pursuant to this chapter. 5
2. An advanced practice registered nurse who holds a 6
certificate from the State Board of Pharmacy authorizing him or her 7
to dispense or to prescribe and dispense controlled substances. 8
3. A scientific investigator or a pharmac y, hospital or other 9
institution licensed, registered or otherwise authorized in this State 10
to distribute, dispense, conduct research with respect to, to 11
administer, or use in teaching or chemical analysis, a controlled 12
substance in the course of professional practice or research. 13
4. A euthanasia technician who is licensed by the Nevada State 14
Board of Veterinary Medical Examiners and registered pursuant to 15
this chapter, while he or she possesses or administers sodium 16
pentobarbital pursuant to his or her license and registration. 17
5. A physician assistant who: 18
(a) Holds a license from the Board of Medical Examiners; and 19
(b) Is authorized by the Board to possess, administer, prescribe 20
or dispense controlled substances under the supervision of a 21
physician as required by chapter 630 of NRS. 22
6. A physician assistant who: 23
(a) Holds a license from the State Board of Osteopathic 24
Medicine; and 25
(b) Is authorized by the Board to possess, administer, prescribe 26
or dispense controlled substances under the supervis ion of an 27
osteopathic physician as required by chapter 633 of NRS. 28
7. An optometrist who is certified by the Nevada State Board 29
of Optometry to prescribe and administer pharmaceutical agents 30
pursuant to NRS 636.288, when the optometrist prescribes or 31
administers pharmaceutical agents within the scope of his or her 32
certification. 33
8. A certified registered nurse anesthetist who orders, 34
prescribes, possesses or administers controlled substances in 35
accordance with NRS 632.2397. 36
9. A pharmacist who [is] : 37
(a) Is registered pursuant to NRS 639.28079 to prescribe and 38
dispense drugs for medication-assisted treatment [.] ; or 39
(b) Prescribes and dispenses drugs or devices or dispenses 40
refills without the authorization of a practitioner, other than a 41
pharmacist, in accordance with section 1 of this act. 42
Sec. 11. NRS 453.128 is hereby amended to read as follows: 43
453.128 1. “Prescription” means: 44

– 11 –

- *AB186_R1*
(a) An order given individually for the person for whom 1
prescribed, directly from a physician, physician assistant licensed 2
pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, 3
optometrist, advanced practice registered nurse, certified register ed 4
nurse anesthetist, pharmacist registered pursuant to NRS 639.28079 5
or acting in accordance with section 1 of this act or veterinarian, or 6
his or her agent, to a pharmacist or indirectly by means of an order 7
signed by the practitioner or an electronic tr ansmission from the 8
practitioner to a pharmacist; or 9
(b) A chart order written for an inpatient specifying drugs which 10
he or she is to take home upon his or her discharge. 11
2. The term does not include a chart order written for an 12
inpatient for use while he or she is an inpatient. 13
Sec. 12. NRS 453.226 is hereby amended to read as follows: 14
453.226 1. Every practitioner or other person who dispenses 15
any controlled substance within this State or who proposes to 16
engage in t he dispensing of any controlled substance within this 17
State shall obtain biennially a registration issued by the Board in 18
accordance with its regulations. A person must present proof that he 19
or she is authorized to access the database of the program 20
established pursuant to NRS 453.162 before the Board may issue or 21
renew a registration. 22
2. A person registered by the Board in accordance with the 23
provisions of NRS 453.011 to 453.552, inclusive, to dispense or 24
conduct research with controlled substances may p ossess, dispense 25
or conduct research with those substances to the extent authorized 26
by the registration and in conformity with the other provisions of 27
those sections. 28
3. The following persons are not required to register and may 29
lawfully possess and distribute controlled substances pursuant to the 30
provisions of NRS 453.011 to 453.552, inclusive: 31
(a) An agent or employee of a registered dispenser of a 32
controlled substance if he or she is acting in the usual course of his 33
or her business or employment; 34
(b) A common or contract carrier or warehouseman, or an 35
employee thereof, whose possession of any controlled substance is 36
in the usual course of business or employment; 37
(c) An ultimate user or a person in possession of any controlled 38
substance pursuant to a lawful order of a physician, physician 39
assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, 40
advanced practice registered nurse, certified registered nurse 41
anesthetist, podiatric physician, pharmacist registered pursuant to 42
NRS 639.28079 or acting in accordance with section 1 of this act 43
or veterinarian or in lawful possession of a schedule V substance; or 44
(d) A physician who: 45

– 12 –

- *AB186_R1*
(1) Holds a locum tenens license issued by the Board of 1
Medical Examiners or a temporary license issued by the State Board 2
of Osteopathic Medicine; and 3
(2) Is registered with the Drug Enforcement Administration 4
at a location outside this State. 5
4. The Board may waive the requirement for registration of 6
certain dispensers if it finds it consistent with the publi c health and 7
safety. 8
5. A separate registration is required at each principal place of 9
business or professional practice where the applicant dispenses 10
controlled substances. 11
6. The Board may inspect the establishment of a registrant or 12
applicant for registration in accordance with the Board’s regulations. 13
Sec. 13. NRS 453.336 is hereby amended to read as follows: 14
453.336 1. Except as otherwise provided in subsection 6, a 15
person shall not knowingly or intentionally pos sess a controlled 16
substance, unless the substance was obtained directly from, or 17
pursuant to, a prescription or order of a physician, physician 18
assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, 19
podiatric physician, optometrist, advanced pr actice registered nurse, 20
certified registered nurse anesthetist, pharmacist registered pursuant 21
to NRS 639.28079 or acting in accordance with section 1 of this 22
act or veterinarian while acting in the course of his or her 23
professional practice, or except as otherwise authorized by the 24
provisions of NRS 453.005 to 453.552, inclusive. 25
2. Except as otherwise provided in subsections 3, 4 and 5 and 26
in NRS 453.3363, and unless a greater penalty is provided in NRS 27
212.160, 453.3385, 453.3387 or 453.339, a person who violates this 28
section: 29
(a) For a first or second offense, if the controlled substance is 30
listed in schedule I or II and the quantity possessed is less than 14 31
grams, or if the controlled substance is listed in schedule III, IV or V 32
and the quantity po ssessed is less than 28 grams, is guilty of 33
possession of a controlled substance and shall be punished for a 34
category E felony as provided in NRS 193.130. In accordance with 35
NRS 176.211, the court shall defer judgment upon the consent of the 36
person. 37
(b) For a third or subsequent offense, if the controlled substance 38
is listed in schedule I or II and the quantity possessed is less than 14 39
grams, or if the controlled substance is listed in schedule III, IV or V 40
and the quantity possessed is less than 28 grams , or if the offender 41
has previously been convicted two or more times in the aggregate of 42
any violation of the law of the United States or of any state, territory 43
or district relating to a controlled substance, is guilty of possession 44
of a controlled substa nce and shall be punished for a category D 45

– 13 –

- *AB186_R1*
felony as provided in NRS 193.130, and may be further punished by 1
a fine of not more than $20,000. 2
(c) If the controlled substance is listed in schedule I or II and the 3
quantity possessed is 14 grams or more, but less than 28 grams, or if 4
the controlled substance is listed in schedule III, IV or V and the 5
quantity possessed is 28 grams or more, but less than 200 grams, is 6
guilty of low-level possession of a controlled substance and shall be 7
punished for a category C felony as provided in NRS 193.130. 8
(d) If the controlled substance is listed in schedule I or II and the 9
quantity possessed is 28 grams or more, but less than 42 grams, or if 10
the controlled substance is listed in schedule III, IV or V and the 11
quantity possessed is 200 grams or more, is guilty of mid -level 12
possession of a controlled substance and shall be punished for a 13
category B felony by imprisonment in the state prison for a 14
minimum term of not less than 1 year and a maximum term of not 15
more than 10 years and by a fine of not more than $50,000. 16
(e) If the controlled substance is listed in schedule I or II and the 17
quantity possessed is 42 grams or more, but less than 100 grams, is 18
guilty of high-level possession of a controlled substance and shall be 19
punished for a category B felony by imprisonment in the state prison 20
for a minimum term of not less than 2 years and a maximum term of 21
not more than 15 years and by a fine of not more than $50,000. 22
3. Unless a greater penalty is provided in NRS 212.160, 23
453.337 or 453.3385, a person who is convicted of the possession of 24
flunitrazepam or gamma -hydroxybutyrate, or any substance for 25
which flunitrazepam or gamma -hydroxybutyrate is an immediate 26
precursor, is guilty of a category B felony and shall be punished by 27
imprisonment in the state prison for a minimum term of not less 28
than 1 year and a maximum term of not more than 6 years. 29
4. Unless a greater penalty is provided pursuant to NRS 30
212.160, a person who is convicted of the possession of 1 ounce or 31
less of marijuana is guilty of a misdemeanor and shall be punished 32
by: 33
(a) Performing not more than 24 hours of community service; 34
(b) Attending the live meeting described in paragraph (a) of 35
subsection 2 of NRS 484C.530 and complying with any other 36
requirements set forth in that section; or 37
(c) Being required to undergo an evaluation in accordance with 38
subsection 1 of NRS 484C.350, 39
 or any combination thereof. 40
5. Unless a greater penalty is provided pursuant to NRS 41
212.160, a person who is convicted of the possession of more than 1 42
ounce, but less than 50 pounds, of marijuana or more than one -43
eighth of an ounce, but less than one pound, of concentrated 44

– 14 –

- *AB186_R1*
cannabis is guilty of a category E felony and shall be punished as 1
provided in NRS 193.130. 2
6. It is not a violation of this section if a person possesses a 3
trace amount of a controlled substance and that trace amount is in or 4
on a hypodermic device obtained from a sterile hypodermic device 5
program pursuant to NRS 439.985 to 439.994, inclusive. 6
7. The court may grant probation to or suspend the sentence of 7
a person convicted of violating this section. 8
8. If a person fulfills the terms and conditions imposed for a 9
violation of subsection 4, the court shall, without a hearing, order 10
sealed all documents, pa pers and exhibits in that person’s record, 11
minute book entries and entries on dockets, and other documents 12
relating to the case in the custody of such other agencies and 13
officers as are named in the court’s order. The court shall cause a 14
copy of the order to be sent to each agency or officer named in the 15
order. Each such agency or officer shall notify the court in writing 16
of its compliance with the order. 17
9. As used in this section: 18
(a) “Controlled substance” includes flunitrazepam, gamma -19
hydroxybutyrate and each substance for which flunitrazepam or 20
gamma-hydroxybutyrate is an immediate precursor. 21
(b) “Marijuana” does not include concentrated cannabis. 22
(c) “Sterile hypodermic device program” has the meaning 23
ascribed to it in NRS 439.986. 24
Sec. 14. NRS 453.375 is hereby amended to read as follows: 25
453.375 1. A controlled substance may be possessed and 26
administered by the following persons: 27
(a) A practitioner. 28
(b) A registered nurse licensed to practice professional nursing 29
or licensed practical nurse, at the direction of a physician, physician 30
assistant, dentist, podiatric physician or advanced practice registered 31
nurse, or pursuant to a chart order, for administration to a patient at 32
another location. 33
(c) A paramedic: 34
(1) As authorized by regulation of: 35
(I) The State Board of Health in a county whose 36
population is less than 100,000; or 37
(II) A county or district board of health in a county whose 38
population is 100,000 or more; and 39
(2) In accordance with any applicable regulations of: 40
(I) The State Board of Health in a county whose 41
population is less than 100,000; 42
(II) A county board of health in a county whose 43
population is 100,000 or more; or 44

– 15 –

- *AB186_R1*
(III) A district board of health created pur suant to NRS 1
439.362 or 439.370 in any county. 2
(d) A respiratory therapist, at the direction of a physician or 3
physician assistant. 4
(e) An anesthesiologist assistant, at the direction of a 5
supervising anesthesiologist or supervising osteopathic 6
anesthesiologist. 7
(f) A medical student, student in training to become a physician 8
assistant or anesthesiologist assistant, student nurse in the course of 9
his or her studies at an accredited college of medicine or approved 10
school of professional or practical nursi ng, at the direction of a 11
physician or physician assistant and: 12
(1) In the presence of a physician, physician assistant or a 13
registered nurse; or 14
(2) Under the supervision of a physician, physician assistant 15
or a registered nurse if the student is auth orized by the college or 16
school to administer the substance outside the presence of a 17
physician, physician assistant or nurse. 18
 A medical student or student nurse may administer a controlled 19
substance in the presence or under the supervision of a register ed 20
nurse alone only if the circumstances are such that the registered 21
nurse would be authorized to administer it personally. 22
(g) An ultimate user or any person whom the ultimate user 23
designates pursuant to a written agreement. 24
(h) Any person designated b y the head of a correctional 25
institution. 26
(i) A veterinary technician at the direction of his or her 27
supervising veterinarian. 28
(j) In accordance with applicable regulations of the State Board 29
of Health, an employee of a residential facility for groups, as 30
defined in NRS 449.017, pursuant to a written agreement entered 31
into by the ultimate user. 32
(k) In accordance with applicable regulations of the State Board 33
of Pharmacy, an animal control officer, a wildlife biologist or an 34
employee designated by a fede ral, state or local governmental 35
agency whose duties include the control of domestic, wild and 36
predatory animals. 37
(l) A person who is enrolled in a training program to become a 38
paramedic, respiratory therapist or veterinary technician if the 39
person posses ses and administers the controlled substance in the 40
same manner and under the same conditions that apply, respectively, 41
to a paramedic, respiratory therapist or veterinary technician who 42
may possess and administer the controlled substance, and under the 43
direct supervision of a person licensed or registered to perform the 44
respective medical art or a supervisor of such a person. 45

– 16 –

- *AB186_R1*
(m) A registered pharmacist . [pursuant to written guidelines and 1
protocols developed pursuant to NRS 639.2629 or a collaborative 2
practice agreement, as defined in NRS 639.0052.] 3
2. As used in this section: 4
(a) “Accredited college of medicine” means: 5
(1) A medical school that is accredited by the Liaison 6
Committee on Medical Education of the American Medical 7
Association and the A ssociation of American Medical Colleges or 8
their successor organizations; or 9
(2) A school of osteopathic medicine, as defined in 10
NRS 633.121. 11
(b) “Anesthesiologist assistant” means a person who holds a 12
license issued pursuant to NRS 630.2683 or 633.4254 or a 13
temporary license issued pursuant to NRS 630.2685 or 633.4262. 14
Sec. 15. NRS 453.381 is hereby amended to read as follows: 15
453.381 1. In addition to the limitations imposed by NRS 16
453.256 and 453.3611 to 453.3648, inclusive, a physician, physician 17
assistant, dentist, advanced practice registered nurse, certified 18
registered nurse anesthetist, podiatric physician or pharmacist 19
registered pursuant to NRS 639.28079 or acting in accordance with 20
section 1 of thi s act may prescribe or administer controlled 21
substances only for a legitimate medical purpose and in the usual 22
course of his or her professional practice, and he or she shall not 23
prescribe, administer or dispense a controlled substance listed in 24
schedule I I for himself or herself, his or her spouse or his or her 25
children except in cases of emergency. 26
2. A veterinarian, in the course of his or her professional 27
practice only, and not for use by a human being, may prescribe, 28
possess and administer controlled substances, and the veterinarian 29
may cause them to be administered by a veterinary technician under 30
the direction and supervision of the veterinarian. 31
3. A euthanasia technician, within the scope of his or her 32
license, and not for use by a human being, may possess and 33
administer sodium pentobarbital. 34
4. A pharmacist shall not fill an order which purports to be a 35
prescription if the pharmacist has reason to believe that it was not 36
issued in the usual course of the professional practice of a physician, 37
physician assistant, dentist, advanced practice registered nurse, 38
certified registered nurse anesthetist, podiatric physician, pharmacist 39
registered pursuant to NRS 639.28079 or acting in accordance with 40
section 1 of this act or veterinarian. 41
5. Any perso n who has obtained from a physician, physician 42
assistant, dentist, advanced practice registered nurse, certified 43
registered nurse anesthetist, podiatric physician, pharmacist 44
registered pursuant to NRS 639.28079 or acting in accordance with 45

– 17 –

- *AB186_R1*
section 1 of th is act or veterinarian any controlled substance for 1
administration to a patient during the absence of the physician, 2
physician assistant, dentist, advanced practice registered nurse, 3
certified registered nurse anesthetist, podiatric physician, pharmacist 4
or veterinarian shall return to him or her any unused portion of the 5
substance when it is no longer required by the patient. 6
6. A manufacturer, wholesale supplier or other person legally 7
able to furnish or sell any controlled substance listed in schedule II 8
shall not provide samples of such a controlled substance to 9
registrants. 10
7. A salesperson of any manufacturer or wholesaler of 11
pharmaceuticals shall not possess, transport or furnish any 12
controlled substance listed in schedule II. 13
8. A person shall not dispense a controlled substance in 14
violation of a regulation adopted by the Board. 15
Sec. 16. NRS 454.00958 is hereby amended to read as 16
follows: 17
454.00958 “Practitioner” means: 18
1. A physician, dentist, veterinarian or podiatric physician who 19
holds a valid license to practice his or her profession in this State. 20
2. A pharmacy, hospital or other institution licensed or 21
registered to distribute, dispense, conduct research with respect to or 22
to administer a dangerous drug in the course of professional practice 23
in this State. 24
3. When relating to the prescription of poisons, dangerous 25
drugs and devices: 26
(a) An advanced practice registered nurse who holds a certificate 27
from the State Board of Pharmacy permitting him or her so to 28
prescribe; or 29
(b) A physician assistant who holds a license from the Board of 30
Medical Examiners and a certificate from the State Board of 31
Pharmacy permitting him or her so to prescribe. 32
4. An optometrist who is certified to prescribe and admin ister 33
pharmaceutical agents pursuant to NRS 636.288 when the 34
optometrist prescribes or administers dangerous drugs which are 35
within the scope of his or her certification. 36
5. A dental hygienist who holds a valid license to practice 37
dental hygiene in this State and: 38
(a) Is authorized to prescribe and dispense the dangerous drugs 39
listed in NRS 631.3105 in accordance with the provisions of that 40
section and the regulations adopted pursuant thereto; and 41
(b) Holds a certificate issued by the State Board of P harmacy 42
pursuant to NRS 639.1374 authorizing him or her to so prescribe. 43

– 18 –

- *AB186_R1*
6. A certified registered nurse anesthetist who orders, 1
prescribes, possesses or administers poisons, dangerous drugs or 2
devices in accordance with NRS 632.2397. 3
7. A pharmacist who [is] : 4
(a) Is registered pursuant to NRS 639.28079 to prescribe and 5
dispense drugs for medication-assisted treatment [.] ; or 6
(b) Prescribes and dispenses drugs or devices or dispenses 7
refills without the authorization of a practitioner, other than a 8
pharmacist, in accordance with section 1 of this act. 9
Sec. 17. NRS 454.213 is hereby amended to read as follows: 10
454.213 1. Except as otherwise provided in NRS 454.217, a 11
drug or medicine referred to in NRS 454.181 to 454.371, inclusive, 12
may be possessed and administered by: 13
(a) A practitioner. 14
(b) A physician assistant licensed pursuant to chapter 630 or 633 15
of NRS or an anesthesiologist assistant, at the direction of his or her 16
supervising physician or supervising anesthesiologist or supervising 17
osteopathic anesthesiologist, as applicable, or a licensed dental 18
hygienist or expanded function dental assistant acting in the office 19
of and under the supervision of a dentist. 20
(c) Except as otherwise provided in paragraph (d), a registered 21
nurse licensed to practice professional nursing or licensed practical 22
nurse, at the direction of a prescribing physician, physician assistant 23
licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric 24
physician or advanced practi ce registered nurse, or pursuant to a 25
chart order, for administration to a patient at another location. 26
(d) In accordance with applicable regulations of the Board, a 27
registered nurse licensed to practice professional nursing or licensed 28
practical nurse who is: 29
(1) Employed by a health care agency or health care facility 30
that is authorized to provide emergency care, or to respond to the 31
immediate needs of a patient, in the residence of the patient; and 32
(2) Acting under the direction of the medical direc tor of that 33
agency or facility who works in this State. 34
(e) A medication aide - certified at a designated facility under 35
the supervision of an advanced practice registered nurse or 36
registered nurse and in accordance with standard protocols 37
developed by the State Board of Nursing. As used in this paragraph, 38
“designated facility” has the meaning ascribed to it in 39
NRS 632.0145. 40
(f) Except as otherwise provided in paragraph (g), an advanced 41
emergency medical technician or a paramedic, as authorized by 42
regulation of the State Board of Pharmacy and in accordance with 43
any applicable regulations of: 44

– 19 –

- *AB186_R1*
(1) The State Board of Health in a county whose population 1
is less than 100,000; 2
(2) A county board of health in a county whose population is 3
100,000 or more; or 4
(3) A district board of health created pursuant to NRS 5
439.362 or 439.370 in any county. 6
(g) An advanced emergency medical technician or a paramedic 7
who holds an endorsement issued pursuant to NRS 450B.1975, 8
under the direct supervision of a local health officer or a designee of 9
the local health officer pursuant to that section. 10
(h) A respiratory therapist employed in a health care facility. 11
The therapist may possess and administer respiratory products only 12
at the direction of a physician. 13
(i) A dialysis technician, under the direction or supervision of a 14
physician or registered nurse only if the drug or medicine is used for 15
the process of renal dialysis. 16
(j) A medical student or student nurse in the course of his or her 17
studies at an accredited college of medicine or approved school of 18
professional or practical nursing, at the direction of a physician and: 19
(1) In the presence of a physician or a registered nurse; or 20
(2) Under the supervision of a physician or a registered nurse 21
if the student is authorized by the college or school to administer the 22
drug or medicine outside the presence of a physician or nurse. 23
 A medical student or student nurse may administer a dangerous 24
drug in the presence or under the supervision of a registered nurse 25
alone only if the circumstances are such that the registered nurse 26
would be authorized to administer it personally. 27
(k) Any person designated by the head of a correctional 28
institution. 29
(l) An ultimate user or any person designated by the ultimate 30
user pursuant to a written agreement. 31
(m) A holder of a license to engage in radiation therapy and 32
radiologic imaging issued pursuant to chapter 653 of NRS, at the 33
direction of a physician and in accordance with any conditions 34
established by regulation of the Board. 35
(n) A chiropractic physician, but only if the drug or medicine is 36
a topical drug used for cooling and stretching external tissue during 37
therapeutic treatments. 38
(o) A physical therapist, but only if the drug or medicine is a 39
topical drug which is: 40
(1) Used for cooling and stretching external tissue during 41
therapeutic treatments; and 42
(2) Prescribed by a licensed physician for: 43
(I) Iontophoresis; or 44

– 20 –

- *AB186_R1*
(II) The transmission of drugs through the skin using 1
ultrasound. 2
(p) In accordance with applicable regulations of the State Board 3
of Health, an employee of a residential facility for groups, as 4
defined in NRS 449.017, pursuant to a written agreement entered 5
into by the ultimate user. 6
(q) A veterinary technician or a veterinary assistant at the 7
direction of his or her supervising veterinarian. 8
(r) [In accordance with applicable regulations of the Board, a 9
registered pharmacist who: 10
(1) Is trained in and certified to carry out standards and 11
practices for immunization programs; 12
(2) Is authorized to administer immunizations pursuant to 13
written protocols from a physician; and 14
(3) Administers immunizations in compliance with the 15
“Standards for Immunization Practices” recommended and 16
approved by the Advisory Committee on Immunization Practices of 17
the Centers for Disease Control and Prevention. 18
(s)] A registered pharmacist . [pursuant to written guidelines and 19
protocols developed pursuant to NRS 639.2629 or a collaborative 20
practice agreement, as defined in NRS 639.0052. 21
(t)] (s) A person who is enroll ed in a training program to 22
become a physician assistant or anesthesiologist assistant licensed 23
pursuant to chapter 630 or 633 of NRS, dental hygienist, advanced 24
emergency medical technician, paramedic, respiratory therapist, 25
dialysis technician, physical therapist or veterinary technician or to 26
obtain a license to engage in radiation therapy and radiologic 27
imaging pursuant to chapter 653 of NRS if the person possesses and 28
administers the drug or medicine in the same manner and under the 29
same conditions tha t apply, respectively, to a physician assistant or 30
anesthesiologist assistant licensed pursuant to chapter 630 or 633 of 31
NRS, dental hygienist, advanced emergency medical technician, 32
paramedic, respiratory therapist, dialysis technician, physical 33
therapist, veterinary technician or person licensed to engage in 34
radiation therapy and radiologic imaging who may possess and 35
administer the drug or medicine, and under the direct supervision of 36
a person licensed or registered to perform the respective medical art 37
or a supervisor of such a person. 38
[(u)] (t) A medical assistant, in accordance with applicable 39
regulations of the: 40
(1) Board of Medical Examiners, at the direction of the 41
prescribing physician and under the supervision of a physician or 42
physician assistant. 43

– 21 –

- *AB186_R1*
(2) State Board of Osteopathic Medicine, at the direction of 1
the prescribing physician and under the supervision of a physician 2
or physician assistant. 3
2. As used in this section, “accredited college of medicine” has 4
the meaning ascribed to it in NRS 453.375. 5
Sec. 18. NRS 689A.0437 is hereby amended to read as 6
follows: 7
689A.0437 1. An insurer that offers or issues a policy of 8
health insurance shall include in the policy coverage for: 9
(a) All drugs approved by the United States Food and Drug 10
Administration for preventing the acquisition of human 11
immunodeficiency virus or treating human immunodeficiency virus 12
or hepatitis C in the form recommended by the prescribing 13
practitioner, regardless of whether the drug is included in the 14
formulary of the insurer; 15
(b) Laboratory testing that is necessary for therapy that uses a 16
drug to prevent the acquisition of human immunodeficiency virus; 17
(c) Any service to test for, prevent or treat human 18
immunodeficiency virus or he patitis C provided by a provider of 19
primary care if the service is covered when provided by a specialist 20
and: 21
(1) The service is within the scope of practice of the provider 22
of primary care; or 23
(2) The provider of primary care is capable of providing the 24
service safely and effectively in consultation with a specialist and 25
the provider engages in such consultation; and 26
(d) [The] Ordering laboratory testing described in paragraph 27
(b) and the services described in NRS 639.28085, when provided by 28
a pharmacist who participates in the network plan of the insurer. 29
2. An insurer that offers or issues a policy of health insurance 30
shall reimburse: 31
(a) A pharmacist who participates in the network plan of the 32
insurer for the services described in [NRS 639.280 85] paragraph 33
(d) of subsection 1 at a rate equal to the rate of reimbursement 34
provided to a physician, physician assistant or advanced practice 35
registered nurse for similar services. 36
(b) An advanced practice registered nurse or a physician 37
assistant who participates in the network plan of the insurer for any 38
service to test for, prevent or treat human immunodeficiency virus 39
or hepatitis C at a rate equal to the rate of reimbursement provided 40
to a physician for similar services. 41
3. An insurer shall not: 42
(a) Subject the benefits required by subsection 1 to medical 43
management techniques, other than step therapy; 44

– 22 –

- *AB186_R1*
(b) Limit the covered amount of a drug described in paragraph 1
(a) of subsection 1; 2
(c) Refuse to cover a drug described in paragraph (a) of 3
subsection 1 because the drug is dispensed by a pharmacy through 4
mail order service; or 5
(d) Prohibit or restrict access to any service or drug to treat 6
human immunodeficiency virus or hepatitis C on the same day on 7
which the insured is diagnosed. 8
4. An insurer shall ensure that the benefits required by 9
subsection 1 are made available to an insured through a provider of 10
health care who participates in the network plan of the insurer. 11
5. A policy of health insurance subject to the provisions of this 12
chapter that is delivered, issued for delivery or renewed on or after 13
January 1, 2024, has the legal effect of including the coverage 14
required by subsection 1, and any provision of the policy that 15
conflicts with the provisions of this section is void. 16
6. As used in this section: 17
(a) “Medical management technique” means a practice which is 18
used to control the cost or use of health care services or prescription 19
drugs. The term includes, without limitation, the use of step therapy, 20
prior authorization a nd categorizing drugs and devices based on 21
cost, type or method of administration. 22
(b) “Network plan” means a policy of health insurance offered 23
by an insurer under which the financing and delivery of medical 24
care, including items and services paid for as medical care, are 25
provided, in whole or in part, through a defined set of providers 26
under contract with the insurer. The term does not include an 27
arrangement for the financing of premiums. 28
(c) “Primary care” means the practice of family medicine, 29
pediatrics, internal medicine, obstetrics and gynecology and 30
midwifery. 31
(d) “Provider of health care” has the meaning ascribed to it in 32
NRS 629.031. 33
Sec. 19. NRS 689B.0312 is hereby amended to read as 34
follows: 35
689B.0312 1. An insurer that offers or issues a policy of 36
group health insurance shall include in the policy coverage for: 37
(a) All drugs approved by the United States Food and Drug 38
Administration for preventing the acquisition of human 39
immunodeficiency virus or treatin g human immunodeficiency virus 40
or hepatitis C in the form recommended by the prescribing 41
practitioner, regardless of whether the drug is included in the 42
formulary of the insurer; 43
(b) Laboratory testing that is necessary for therapy that uses a 44
drug to prevent the acquisition of human immunodeficiency virus; 45

– 23 –

- *AB186_R1*
(c) Any service to test for, prevent or treat human 1
immunodeficiency virus or hepatitis C provided by a provider of 2
primary care if the service is covered when provided by a specialist 3
and: 4
(1) The service is within the scope of practice of the provider 5
of primary care; or 6
(2) The provider of primary care is capable of providing the 7
service safely and effectively in consultation with a specialist and 8
the provider engages in such consultation; and 9
(d) [The] Ordering laboratory testing described in paragraph 10
(b) and the services described in NRS 639.28085, when provided by 11
a pharmacist who participates in the network plan of the insurer. 12
2. An insurer that offers or issues a policy of group health 13
insurance shall reimburse: 14
(a) A pharmacist who participates in the network plan of the 15
insurer for the services described in [NRS 639.28085 ] paragraph 16
(d) of subsection 1 at a rate equal to the rate of reimbursement 17
provided to a physician, physic ian assistant or advanced practice 18
registered nurse for similar services. 19
(b) An advanced practice registered nurse or a physician 20
assistant who participates in the network plan of the insurer for any 21
service to test for, prevent or treat human immunodefi ciency virus 22
or hepatitis C at a rate equal to the rate of reimbursement provided 23
to a physician for similar services. 24
3. An insurer shall not: 25
(a) Subject the benefits required by subsection 1 to medical 26
management techniques, other than step therapy; 27
(b) Limit the covered amount of a drug described in paragraph 28
(a) of subsection 1; 29
(c) Refuse to cover a drug described in paragraph (a) of 30
subsection 1 because the drug is dispensed by a pharmacy through 31
mail order service; or 32
(d) Prohibit or restric t access to any service or drug to treat 33
human immunodeficiency virus or hepatitis C on the same day on 34
which the insured is diagnosed. 35
4. An insurer shall ensure that the benefits required by 36
subsection 1 are made available to an insured through a provi der of 37
health care who participates in the network plan of the insurer. 38
5. A policy of group health insurance subject to the provisions 39
of this chapter that is delivered, issued for delivery or renewed on or 40
after January 1, 2024, has the legal effect o f including the coverage 41
required by subsection 1, and any provision of the policy that 42
conflicts with the provisions of this section is void. 43
6. As used in this section: 44

– 24 –

- *AB186_R1*
(a) “Medical management technique” means a practice which is 1
used to control the cost or use of health care services or prescription 2
drugs. The term includes, without limitation, the use of step therapy, 3
prior authorization and categorizing drugs and devices based on 4
cost, type or method of administration. 5
(b) “Network plan” means a policy of group health insurance 6
offered by an insurer under which the financing and delivery of 7
medical care, including items and services paid for as medical care, 8
are provided, in whole or in part, through a defined set of providers 9
under contract with the insurer. The term does not include an 10
arrangement for the financing of premiums. 11
(c) “Primary care” means the practice of family medicine, 12
pediatrics, internal medicine, obstetrics and gynecology and 13
midwifery. 14
(d) “Provider of health care” has the meaning ascribed to it in 15
NRS 629.031. 16
Sec. 20. NRS 689C.1671 is hereby amended to read as 17
follows: 18
689C.1671 1. A carrier that offers or issues a health benefit 19
plan shall include in the plan coverage for: 20
(a) All drugs approved by the United States Food and Drug 21
Administration for preventing the acquisition of human 22
immunodeficiency virus or treating human immunodeficiency virus 23
or hepatitis C in the form recommended by the prescribing 24
practitioner, regardless of whether the drug is included in the 25
formulary of the carrier; 26
(b) Laboratory testing that is necessary for therapy that uses a 27
drug to prevent the acquisition of human immunodeficiency virus; 28
(c) Any service to test for, prevent or treat human 29
immunodeficiency virus or hepatitis C provided by a provider of 30
primary care if the service is covered when provided by a specialist 31
and: 32
(1) The service is within the scope of practice of the provider 33
of primary care; or 34
(2) The provider of primary care i s capable of providing the 35
service safely and effectively in consultation with a specialist and 36
the provider engages in such consultation; and 37
(d) [The] Ordering laboratory testing described in paragraph 38
(b) and the services described in NRS 639.28085, when provided by 39
a pharmacist who participates in the health benefit plan of the 40
carrier. 41
2. A carrier that offers or issues a health benefit plan shall 42
reimburse: 43
(a) A pharmacist who participates in the health benefit plan of 44
the carrier for the services described in [NRS 639.28085] paragraph 45

– 25 –

- *AB186_R1*
(d) of subsection 1 at a rate equal to the rate of reimbursement 1
provided to a physician, physician assistant or advanced pr actice 2
registered nurse for similar services. 3
(b) An advanced practice registered nurse or a physician 4
assistant who participates in the network plan of the carrier for any 5
service to test for, prevent or treat human immunodeficiency virus 6
or hepatitis C at a rate equal to the rate of reimbursement provided 7
to a physician for similar services. 8
3. A carrier shall not: 9
(a) Subject the benefits required by subsection 1 to medical 10
management techniques, other than step therapy; 11
(b) Limit the covered amou nt of a drug described in paragraph 12
(a) of subsection 1; 13
(c) Refuse to cover a drug described in paragraph (a) of 14
subsection 1 because the drug is dispensed by a pharmacy through 15
mail order service; or 16
(d) Prohibit or restrict access to any service or dr ug to treat 17
human immunodeficiency virus or hepatitis C on the same day on 18
which the insured is diagnosed. 19
4. A carrier shall ensure that the benefits required by 20
subsection 1 are made available to an insured through a provider of 21
health care who participates in the network plan of the carrier. 22
5. A health benefit plan subject to the provisions of this chapter 23
that is delivered, issued for delivery or renewed on or after 24
January 1, 2024, has the legal effect of including the coverage 25
required by subsection 1, and any provision of the plan that conflicts 26
with the provisions of this section is void. 27
6. As used in this section: 28
(a) “Medical management technique” means a practice which is 29
used to control the cost or use of health care services or pres cription 30
drugs. The term includes, without limitation, the use of step therapy, 31
prior authorization and categorizing drugs and devices based on 32
cost, type or method of administration. 33
(b) “Network plan” means a health benefit plan offered by a 34
carrier und er which the financing and delivery of medical care, 35
including items and services paid for as medical care, are provided, 36
in whole or in part, through a defined set of providers under contract 37
with the carrier. The term does not include an arrangement for the 38
financing of premiums. 39
(c) “Primary care” means the practice of family medicine, 40
pediatrics, internal medicine, obstetrics and gynecology and 41
midwifery. 42
(d) “Provider of health care” has the meaning ascribed to it in 43
NRS 629.031. 44

– 26 –

- *AB186_R1*
Sec. 21. NRS 695A.1843 is hereby amended to read as 1
follows: 2
695A.1843 1. A society that offers or issues a benefit 3
contract shall include in the benefit coverage for: 4
(a) All drugs approved by the United States Food and Dru g 5
Administration for preventing the acquisition of human 6
immunodeficiency virus or treating human immunodeficiency virus 7
or hepatitis C in the form recommended by the prescribing 8
practitioner, regardless of whether the drug is included in the 9
formulary of the society; 10
(b) Laboratory testing that is necessary for therapy that uses a 11
drug to prevent the acquisition of human immunodeficiency virus; 12
(c) Any service to test for, prevent or treat human 13
immunodeficiency virus or hepatitis C provided by a provider of 14
primary care if the service is covered when provided by a specialist 15
and: 16
(1) The service is within the scope of practice of the provider 17
of primary care; or 18
(2) The provider of primary care is capable of providing the 19
service safely and e ffectively in consultation with a specialist and 20
the provider engages in such consultation; and 21
(d) [The] Ordering laboratory testing described in paragraph 22
(b) and the services described in NRS 639.28085, when provided by 23
a pharmacist who participates in the network plan of the society. 24
2. A society that offers or issues a benefit contract shall 25
reimburse: 26
(a) A pharmacist who participates in the network plan of the 27
society for the services described in [NRS 639.28085] paragraph 28
(d) of subsection 1 at a rate equal to the rate of reimbursement 29
provided to a physician, physician assistant or advanced practice 30
registered nurse for similar services. 31
(b) An advanced practice registered nurse or a physician 32
assistant who participates in the network plan of the society for any 33
service to test for, prevent or treat human immunodeficiency virus 34
or hepatitis C at a rate equal to the rate of reimbursement provided 35
to a physician for similar services. 36
3. A society shall not: 37
(a) Subject the benefits required by subsection 1 to medical 38
management techniques, other than step therapy; 39
(b) Limit the covered amount of a drug described in paragraph 40
(a) of subsection 1; 41
(c) Refuse to cover a drug described in paragraph (a) of 42
subsection 1 because the drug is disp ensed by a pharmacy through 43
mail order service; or 44

– 27 –

- *AB186_R1*
(d) Prohibit or restrict access to any service or drug to treat 1
human immunodeficiency virus or hepatitis C on the same day on 2
which the insured is diagnosed. 3
4. A society shall ensure that the benefits required by 4
subsection 1 are made available to an insured through a provider of 5
health care who participates in the network plan of the society. 6
5. A benefit contract subject to the provisions of this chapter 7
that is delivered, issued for delivery or r enewed on or after 8
January 1, 2024, has the legal effect of including the coverage 9
required by subsection 1, and any provision of the plan that conflicts 10
with the provisions of this section is void. 11
6. As used in this section: 12
(a) “Medical management technique” means a practice which is 13
used to control the cost or use of health care services or prescription 14
drugs. The term includes, without limitation, the use of step therapy, 15
prior authorization and categorizing drugs and devices based on 16
cost, type or method of administration. 17
(b) “Network plan” means a benefit contract offered by a society 18
under which the financing and delivery of medical care, including 19
items and services paid for as medical care, are provided, in whole 20
or in part, through a defined set of providers under contract with the 21
society. The term does not include an arrangement for the financing 22
of premiums. 23
(c) “Primary care” means the practice of family medicine, 24
pediatrics, internal medicine, obstetrics and gynecology and 25
midwifery. 26
(d) “Provider of health care” has the meaning ascribed to it in 27
NRS 629.031. 28
Sec. 22. NRS 695B.1924 is hereby amended to read as 29
follows: 30
695B.1924 1. A hospital or medical services corporation that 31
offers or issues a policy of health insurance shall include in the 32
policy coverage for: 33
(a) All drugs approved by the United States Food and Drug 34
Administration for preventing the acquisition of human 35
immunodeficiency virus or treating human immunodeficiency virus 36
or hepat itis C in the form recommended by the prescribing 37
practitioner, regardless of whether the drug is included in the 38
formulary of the hospital or medical services organization; 39
(b) Laboratory testing that is necessary for therapy using a drug 40
to prevent the acquisition of human immunodeficiency virus; 41
(c) Any service to test for, prevent or treat human 42
immunodeficiency virus or hepatitis C provided by a provider of 43
primary care if the service is covered when provided by a specialist 44
and: 45

– 28 –

- *AB186_R1*
(1) The service is within the scope of practice of the provider 1
of primary care; or 2
(2) The provider of primary care is capable of providing the 3
service safely and effectively in consultation with a specialist and 4
the provider engages in such consultation; and 5
(d) [The] Ordering laboratory testing described in paragraph 6
(b) and the services described in NRS 639.28085, when provided by 7
a pharmacist who participates in the network plan of the hospital or 8
medical services corporation. 9
2. A hospital or medical services co rporation that offers or 10
issues a policy of health insurance shall reimburse: 11
(a) A pharmacist who participates in the network plan of the 12
hospital or medical services corporation for the services described in 13
[NRS 639.28085] paragraph (d) of subsection 1 at a rate equal to 14
the rate of reimbursement provided to a physician, physician 15
assistant or advanced practice registered nurse for similar services. 16
(b) An advanced practice registered nurse or a physician 17
assistant who participates in the network plan of the hospital or 18
medical services corporation for any service to test for, prevent or 19
treat human immunodeficiency virus or hepatitis C at a rate equal to 20
the rate of reimbursement provided to a physician for similar 21
services. 22
3. A hospital or medical services corporation shall not: 23
(a) Subject the benefits required by subsection 1 to medical 24
management techniques, other than step therapy; 25
(b) Limit the covered amount of a drug described in paragraph 26
(a) of subsection 1; 27
(c) Refuse to cover a drug described in paragraph (a) of 28
subsection 1 because the drug is dispensed by a pharmacy through 29
mail order service; or 30
(d) Prohibit or restrict access to any service or drug to treat 31
human immunodeficiency virus or hepatitis C on the same day on 32
which the insured is diagnosed. 33
4. A hospital or medical services corporation shall ensure that 34
the benefits required by subsection 1 are made available to an 35
insured through a provider of health care who participates in the 36
network plan of the hospital or medical services corporation. 37
5. A policy of health insurance subject to the provisions of this 38
chapter that is delivered, issued for delivery or renewed on or after 39
January 1, 2024, has the legal effect of including the coverage 40
required by subsection 1, and a ny provision of the policy that 41
conflicts with the provisions of this section is void. 42
6. As used in this section: 43
(a) “Medical management technique” means a practice which is 44
used to control the cost or use of health care services or prescription 45

– 29 –

- *AB186_R1*
drugs. The term includes, without limitation, the use of step therapy, 1
prior authorization and categorizing drugs and devices based on 2
cost, type or method of administration. 3
(b) “Network plan” means a policy of health insurance offered 4
by a hospital or medica l services corporation under which the 5
financing and delivery of medical care, including items and services 6
paid for as medical care, are provided, in whole or in part, through a 7
defined set of providers under contract with the hospital or medical 8
services corporation. The term does not include an arrangement for 9
the financing of premiums. 10
(c) “Primary care” means the practice of family medicine, 11
pediatrics, internal medicine, obstetrics and gynecology and 12
midwifery. 13
(d) “Provider of health care” has the meaning ascribed to it in 14
NRS 629.031. 15
Sec. 23. NRS 695C.1743 is hereby amended to read as 16
follows: 17
695C.1743 1. A health maintenance organization that offers 18
or issues a health care plan shall include in the plan coverage for: 19
(a) All drugs approved by the United States Food and Drug 20
Administration for preventing the acquisition of human 21
immunodeficiency virus or treating human immunodeficiency virus 22
or hepatitis C in the form recommended by the prescribing 23
practitioner, regardless of whether the drug is included in the 24
formulary of the health maintenance organization; 25
(b) Laboratory testing that is necessary for therapy that uses a 26
drug to prevent the acquisition of human immunodeficiency virus; 27
(c) Any service to test for, prevent or treat human 28
immunodeficiency virus or hepatitis C provided by a provider of 29
primary care if the service is covered when provided by a specialist 30
and: 31
(1) The service is within the scope of practice of the provider 32
of primary care; or 33
(2) The provider of primary care is capable of providing the 34
service safely and effectively in consultation with a specialist and 35
the provider engages in such consultation; and 36
(d) [The] Ordering laboratory testing described in paragraph 37
(b) and the services described in NRS 639.28085, when provided by 38
a pharmacist who participates in the network plan of the health 39
maintenance organization. 40
2. A health maintenance organi zation that offers or issues a 41
health care plan shall reimburse: 42
(a) A pharmacist who participates in the network plan of the 43
health maintenance organization for the services described in [NRS 44
639.28085] paragraph (d) of subsection 1 at a rate equal to th e rate 45

– 30 –

- *AB186_R1*
of reimbursement provided to a physician, physician assistant or 1
advanced practice registered nurse for similar services. 2
(b) An advanced practice registered nurse or a physician 3
assistant who participates in the network plan of the health 4
maintenance organization for any service to test for, prevent or treat 5
human immunodeficiency virus or hepatitis C at a rate equal to the 6
rate of reimbursement provided to a physician for similar services. 7
3. A health maintenance organization shall not: 8
(a) Subject the benefits required by subsection 1 to medical 9
management techniques, other than step therapy; 10
(b) Limit the covered amount of a drug described in paragraph 11
(a) of subsection 1; 12
(c) Refuse to cover a drug described in paragraph (a) of 13
subsection 1 because the drug is dispensed by a pharmacy through 14
mail order service; or 15
(d) Prohibit or restrict access to any service or drug to treat 16
human immunodeficiency virus or hepatitis C on the same day on 17
which the enrollee is diagnosed. 18
4. A health m aintenance organization shall ensure that the 19
benefits required by subsection 1 are made available to an enrollee 20
through a provider of health care who participates in the network 21
plan of the health maintenance organization. 22
5. A health care plan subjec t to the provisions of this chapter 23
that is delivered, issued for delivery or renewed on or after 24
January 1, 2024, has the legal effect of including the coverage 25
required by subsection 1, and any provision of the plan that conflicts 26
with the provisions of this section is void. 27
6. As used in this section: 28
(a) “Medical management technique” means a practice which is 29
used to control the cost or use of health care services or prescription 30
drugs. The term includes, without limitation, the use of step therapy, 31
prior authorization and categorizing drugs and devices based on 32
cost, type or method of administration. 33
(b) “Network plan” means a health care plan offered by a health 34
maintenance organization under which the financing and delivery of 35
medical care, including items and services paid for as medical care, 36
are provided, in whole or in part, through a defined set of providers 37
under contract with the health maintenance organization. The term 38
does not include an arrangement for the financing of premiums. 39
(c) “Primary care” means the practice of family medicine, 40
pediatrics, internal medicine, obstetrics and gynecology and 41
midwifery. 42
(d) “Provider of health care” has the meaning ascribed to it in 43
NRS 629.031. 44

– 31 –

- *AB186_R1*
Sec. 24. NRS 69 5G.1705 is hereby amended to read as 1
follows: 2
695G.1705 1. A managed care organization that offers or 3
issues a health care plan shall include in the plan coverage for: 4
(a) All drugs approved by the United States Food and Drug 5
Administration for preven ting the acquisition of human 6
immunodeficiency virus or treating human immunodeficiency virus 7
or hepatitis C in the form recommended by the prescribing 8
practitioner, regardless of whether the drug is included in the 9
formulary of the managed care organization; 10
(b) Laboratory testing that is necessary for therapy that uses a 11
drug to prevent the acquisition of human immunodeficiency virus; 12
(c) Any service to test for, prevent or treat human 13
immunodeficiency virus or hepatitis C provided by a provider of 14
primary care if the service is covered when provided by a specialist 15
and: 16
(1) The service is within the scope of practice of the provider 17
of primary care; or 18
(2) The provider of primary care is capable of providing the 19
service safely and effectively in c onsultation with a specialist and 20
the provider engages in such consultation; and 21
(d) [The] Ordering laboratory testing described in paragraph 22
(b) and the services described in NRS 639.28085, when provided by 23
a pharmacist who participates in the network plan of the managed 24
care organization. 25
2. A managed care organization that offers or issues a health 26
care plan shall reimburse: 27
(a) A pharmacist who part icipates in the network plan of the 28
managed care organization for the services described in [NRS 29
639.28085] paragraph (d) of subsection 1 at a rate equal to the rate 30
of reimbursement provided to a physician, physician assistant or 31
advanced practice registered nurse for similar services. 32
(b) An advanced practice registered nurse or a physician 33
assistant who participates in the network plan of the managed care 34
organization for any service to test for, prevent or treat human 35
immunodeficiency virus or hepatiti s C at a rate equal to the rate of 36
reimbursement provided to a physician for similar services. 37
3. A managed care organization shall not: 38
(a) Subject the benefits required by subsection 1 to medical 39
management techniques, other than step therapy; 40
(b) Limit the covered amount of a drug described in paragraph 41
(a) of subsection 1; 42
(c) Refuse to cover a drug described in paragraph (a) of 43
subsection 1 because the drug is dispensed by a pharmacy through 44
mail order service; or 45

– 32 –

- *AB186_R1*
(d) Prohibit or restrict access to any service or drug to treat 1
human immunodeficiency virus or hepatitis C on the same day on 2
which the insured is diagnosed. 3
4. A managed care organization shall ensure that the benefits 4
required by subsection 1 are made available to an insured throug h a 5
provider of health care who participates in the network plan of the 6
managed care organization. 7
5. A health care plan subject to the provisions of this chapter 8
that is delivered, issued for delivery or renewed on or after 9
January 1, 2024, has the le gal effect of including the coverage 10
required by subsection 1, and any provision of the plan that conflicts 11
with the provisions of this section is void. 12
6. As used in this section: 13
(a) “Medical management technique” means a practice which is 14
used to control the cost or use of health care services or prescription 15
drugs. The term includes, without limitation, the use of step therapy, 16
prior authorization and categorizing drugs and devices based on 17
cost, type or method of administration. 18
(b) “Network plan ” means a health care plan offered by a 19
managed care organization under which the financing and delivery 20
of medical care, including items and services paid for as medical 21
care, are provided, in whole or in part, through a defined set of 22
providers under con tract with the managed care organization. The 23
term does not include an arrangement for the financing of 24
premiums. 25
(c) “Primary care” means the practice of family medicine, 26
pediatrics, internal medicine, obstetrics and gynecology and 27
midwifery. 28
(d) “Provider of health care” has the meaning ascribed to it in 29
NRS 629.031. 30
Sec. 25. 1. This section becomes effective upon passage and 31
approval. 32
2. Sections 1 to 24, inclusive, of this act become effective: 33
(a) Upon passage and approval for the purpose of adopting any 34
regulations and performing any other preparatory administrative 35
tasks that are necessary to carry out the provisions of this act; and 36
(b) On January 1, 2026, for all other purposes. 37

H