Revises requirements relating to coverage under Medicaid for certain services provided by pharmacists. (BDR 38-218)

S.B. 118

- *SB118*

SENATE BILL NO. 118–SENATOR STONE

PREFILED JANUARY 27, 2025
____________

Referred to Committee on Health and Human Services

SUMMARY—Revises requirements relating to coverage under
Medicaid for certain services provided by
pharmacists. (BDR 38-218)

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

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

AN ACT relating to Medicaid; requiring Medicaid to include
coverage for certain services provided by a pharmacist;
imposing requirements relating to the rate of
reimbursement that a pharmacist must receive for services
covered under Medicaid ; prohibiting Medicaid or a
managed care organization that provides health care
services to recipients of Medicaid from requiring prior
authorization for the services of a pharmacist under
certain circumstances ; and providing other matters
properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires the Department of Health and Human Services to 1
administer Medicaid. (NRS 422.270) Section 1 of this bill requires the Director of 2
the Department to include under Medicaid: (1) coverage for services provided by a 3
pharmacist within his or her scope of practice if such services are covered when 4
performed by another provider of health care; and (2) reimbursement for such 5
services at an amount equal to or greater than the amount reimbursed to a 6
physician, physician assistant or advanced practice registered nurse for similar 7
services. Sections 1 and 5 of this bill prohibit Medicaid or a managed care 8
organization that provides health care services to recipients of Medicaid from 9
requiring prior authorization for such a service if prior authorization is not required 10
when the service is performed by another provider of health care. Sections 2, 3 and 11
6 of this bill remove requirements related to coverage under Medicaid for specific 12
services provided by pharmacists because section 1 would provide for the coverage 13
of such services. Section 4 of this bill makes a conforming change to indicate that 14
the provisions of section 1 will be administered in the same manner as other 15
provisions of existing law governing Medicaid. 16

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

Section 1. Chapter 422 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. To the extent that federal financial participation is 3
available, the Director shall include under Medicaid coverage for 4
services provided by a pharmacist that are: 5
(a) Within the authorized scope of practice of the pharmacist; 6
and 7
(b) Covered when provided by another provider of health care. 8
2. Medicaid must not limit: 9
(a) Coverage for services provided by a pharmacist to a 10
number of occasions less than for such services when provided by 11
another provider of health care. 12
(b) Reimbursement for services provided by a pharmacist to an 13
amount less than the amount reimbursed for similar services 14
provided by a physician, physician assistant or advanced practice 15
registered nurse. 16
3. Medicaid or a managed care organization, including a 17
health maintenance organization, that provides health care 18
services to recipients of Medicaid shall not require a recipient of 19
Medicaid to obtain prior authorization for any service provided by 20
a pharmacist that is not required for the service when provided by 21
another provider of health care. 22
4. As used in this section: 23
(a) “Health maintenance organization” has the meaning 24
ascribed to it in NRS 695C.030. 25
(b) “Managed care organization” has the meaning ascribed to 26
it in NRS 695G.050. 27
(c) “Provider of health care” has the meaning ascribed to it in 28
NRS 629.031. 29
Sec. 2. NRS 422.27172 is hereby amended to read as follows: 30
422.27172 1. The Director shall include in the State Plan for 31
Medicaid a requirement that the State pay the nonfederal share of 32
expenditures incurred for: 33
(a) Up to a 12 -month supply, per prescription, of any type of 34
drug for contraception or its therapeutic equivalent which is: 35
(1) Lawfully prescribed or ordered; 36
(2) Approved by the Food and Drug Administration; and 37
(3) Dispensed in accordance with NRS 639.28075; 38
(b) Any type of device for contraception which is lawfully 39
prescribed or ordered and which has been approved by the Food and 40
Drug Administration; 41

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(c) Self-administered hormonal contraceptives dispensed by a 1
pharmacist pursuant to NRS 639.28078; 2
(d) Insertion or removal of a device for contraception, including, 3
without limitation, the insertion of such a device at a hospital 4
immediately after a person gives birth; 5
(e) A contraceptive injection, including, without limitation, such 6
an injection immediately after a person gives birth. 7
(f) Education and counseling relating to the initiation of the use 8
of contraceptives and any necessar y follow-up after initiating such 9
use; 10
(g) Management of side effects relating to contraception; and 11
(h) Voluntary sterilization for women. 12
2. Except as otherwise provided in subsections 4 and 5, to 13
obtain any benefit provided in the Plan pursuant to s ubsection 1, a 14
person enrolled in Medicaid must not be required to: 15
(a) Pay a higher deductible, any copayment or coinsurance; or 16
(b) Be subject to a longer waiting period or any other condition. 17
3. The Director shall ensure that the provisions of this section 18
are carried out in a manner which complies with the requirements 19
established by the Drug Use Review Board and set forth in the list 20
of preferred prescription drugs established by the Department 21
pursuant to NRS 422.4025. 22
4. The Plan may require a person enrolled in Medicaid to pay a 23
higher deductible, copayment or coinsurance for a drug for 24
contraception if the person refuses to accept a therapeutic equivalent 25
of the contraceptive drug. 26
5. For each method of contraception which is approved by th e 27
Food and Drug Administration, the Plan must include at least one 28
contraceptive drug or device for which no deductible, copayment or 29
coinsurance may be charged to the person enrolled in Medicaid, but 30
the Plan may charge a deductible, copayment or coinsurance for any 31
other contraceptive drug or device that provides the same method of 32
contraception. If the Plan requires a person enrolled in Medicaid to 33
pay a copayment or coinsurance for a drug for contraception, the 34
Plan may only require the person to pay th e copayment or 35
coinsurance: 36
(a) Once for the entire amount of the drug dispensed for the plan 37
year; or 38
(b) Once for each 1-month supply of the drug dispensed. 39
6. [The Plan must provide for the reimbursement of a 40
pharmacist for providing services descri bed in subsection 1 that are 41
within the scope of practice of the pharmacist to the same extent as 42
if the services were provided by another provider of health care. The 43
Plan must not limit: 44

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(a) Coverage for such services provided by a pharmacist to a 1
number of occasions less than the coverage for such services when 2
provided by another provider of health care. 3
(b) Reimbursement for such services provided by a pharmacist 4
to an amount less than the amount reimbursed for similar services 5
provided by a phy sician, physician assistant or advanced practice 6
registered nurse. 7
7.] The Plan must not require a recipient of Medicaid to obtain 8
prior authorization for the benefits described in paragraphs (a) and 9
(c) of subsection 1. 10
[8.] 7. As used in this section: 11
(a) “Drug Use Review Board” has the meaning ascribed to it in 12
NRS 422.402. 13
(b) “Provider of health care” has the meaning ascribed to it in 14
NRS 629.031. 15
(c) “Therapeutic equivalent” means a drug which: 16
(1) Contains an identical amount of the s ame active 17
ingredients in the same dosage and method of administration as 18
another drug; 19
(2) Is expected to have the same clinical effect when 20
administered to a patient pursuant to a prescription or order as 21
another drug; and 22
(3) Meets any other criteri a required by the Food and Drug 23
Administration for classification as a therapeutic equivalent. 24
Sec. 3. NRS 422.27235 is hereby amended to read as follows: 25
422.27235 1. The Director shall include in the State Plan for 26
Medicaid a requirement that the State pay the nonfederal share of 27
expenditures incurred for: 28
(a) Any laboratory testing that is necessary for therapy that uses 29
a drug approved by the United States Food and Drug Administration 30
for preventing the acquisition of human immunodeficiency virus. 31
(b) [The services of a pharmacist described in NRS 639.28085. 32
The State must provide reimbursement for such services at a rate 33
equal to the rate of reimbursement provided to a physician, 34
physician assistant or advanced pra ctice registered nurse for similar 35
services. 36
(c)] Any service to test for, prevent or treat human 37
immunodeficiency virus or hepatitis C provided by a provider of 38
primary care if the service is covered when provided by a specialist 39
and: 40
(1) The service is within the scope of practice of the provider 41
of primary care; or 42
(2) The provider of primary care is capable of providing the 43
service safely and effectively in consultation with a specialist and 44
the provider engages in such consultation. 45

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2. The Director shall include in the State Plan for Medicaid a 1
requirement that the State reimburse an advanced practice registered 2
nurse or a physician assistant for any service to test for, prevent or 3
treat human immunodeficiency virus or hepatitis C at a rate equa l to 4
the rate of reimbursement provided to a physician for similar 5
services. 6
3. As used in this section, “primary care” means the practice of 7
family medicine, pediatrics, internal medicine, obstetrics and 8
gynecology and midwifery. 9
Sec. 4. NRS 232.320 is hereby amended to read as follows: 10
232.320 1. The Director: 11
(a) Shall appoint, with the consent of the Governor, 12
administrators of the divisions of the Department, who are 13
respectively designated as follows: 14
(1) The Administrator of the Aging and Disability Services 15
Division; 16
(2) The Administrator of the Division of Welfare and 17
Supportive Services; 18
(3) The Administrator of the Division of Child and Family 19
Services; 20
(4) The Administrator of the Division of Health Care 21
Financing and Policy; and 22
(5) The Administrator of the Division of Public and 23
Behavioral Health. 24
(b) Shall administer, through the divisions of the Department, 25
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 26
inclusive, 446 to 450, incl usive, 458A and 656A of NRS, NRS 27
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 28
section 1 of this act, 422.580, 432.010 to 432.133, inclu sive, 29
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 30
and 445A.010 to 445A.055, inclusive, and all other provisions of 31
law relating to the functions of the divisions of the Department, but 32
is not responsible for the clinical activities of the Division of Public 33
and Behavioral Health or the professional line activities of the other 34
divisions. 35
(c) Shall administer any state program for persons with 36
developmental disabilities established pursuant to the 37
Developmental Disabilities Assistance and Bill of Rights Act of 38
2000, 42 U.S.C. §§ 15001 et seq. 39
(d) Shall, after considering advice from agencies of local 40
governments and nonprofit organizations which provide social 41
services, adopt a master plan for the provision of human services in 42
this State. The Director shall revise the plan biennially and deliver a 43
copy of the plan to the Governor and the Legislature at the 44
beginning of each regular session. The plan must: 45

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(1) Identify and assess the plans and programs of the 1
Department for the provis ion of human services, and any 2
duplication of those services by federal, state and local agencies; 3
(2) Set forth priorities for the provision of those services; 4
(3) Provide for communication and the coordination of those 5
services among nonprofit organi zations, agencies of local 6
government, the State and the Federal Government; 7
(4) Identify the sources of funding for services provided by 8
the Department and the allocation of that funding; 9
(5) Set forth sufficient information to assist the Department 10
in providing those services and in the planning and budgeting for the 11
future provision of those services; and 12
(6) Contain any other information necessary for the 13
Department to communicate effectively with the Federal 14
Government concerning demographic trends, formulas for the 15
distribution of federal money and any need for the modification of 16
programs administered by the Department. 17
(e) May, by regulation, require nonprofit organizations and state 18
and local governmental agencies to provide information r egarding 19
the programs of those organizations and agencies, excluding 20
detailed information relating to their budgets and payrolls, which the 21
Director deems necessary for the performance of the duties imposed 22
upon him or her pursuant to this section. 23
(f) Has such other powers and duties as are provided by law. 24
2. Notwithstanding any other provision of law, the Director, or 25
the Director’s designee, is responsible for appointing and removing 26
subordinate officers and employees of the Department. 27
Sec. 5. NRS 687B.225 is hereby amended to read as follows: 28
687B.225 1. Except as otherwise provided in NRS 29
689A.0405, 689A.0412 , 689A.0413, 689A.0418, 689A.0437, 30
689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 31
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 32
689B.0378, 689C.1665, 689C.1671, 689C .1675, 689C.1676, 33
695A.1843, 695 A.1856, 695A.1865, 695A.1874, 695B.1912, 34
695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 35
695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 36
695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 37
695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 38
695G.1719 and 695G.177 [,] and section 1 of this act, any contract 39
for group, blanket or individual health insurance or any contract by 40
a nonprofit hospital, medical or dental service corporation or 41
organization for dental care which provides for payment of a certain 42
part of medical or dental care may require the insured or member to 43
obtain prior authorization for that care from the insurer or 44
organization. The insurer or organization shall: 45

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(a) File its procedure for obtaining approval of care pursuant to 1
this section for approval by the Commissioner; and 2
(b) Unless a shorter time period is prescribed by a specific 3
statute, including, wit hout limitation, NRS 689A.0446, 689B.0361, 4
689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703 , 5
respond to any request for approval by the insured or member 6
pursuant to this section within 20 days after it receives the request. 7
2. The procedure fo r prior authorization may not discriminate 8
among persons licensed to provide the covered care. 9
Sec. 6. NRS 422.27237 is hereby repealed. 10
Sec. 7. 1. This section becomes effective upon passage and 11
approval. 12
2. Sections 1 to 6, inclusive, of this act become effective: 13
(a) Upon passage and approval for the purpose of adopting any 14
regulations and performing any other preparatory administrative 15
tasks that are necessary to carry out the provisions of this act; 16
(b) On January 1, 2026, for all other purposes. 17

TEXT OF REPEALED SECTION

422.27237 State Plan for Medicaid: Inclusion of
requirement for payment of certain costs for services of
pharmacist; rate of reimbursement.
1. The Director shall include in the State Plan for Medicaid a
requirement that the State pay the nonfederal share of expenditures
incurred for the services of a pharmacist described in
NRS 639.28079.
2. The State must provide reimbursement for the services of a
pharmacist described in NRS 639.28079 at a rate equal to the rate of
reimbursement provided to a physician, physician assistant or
advanced practice registered nurse for similar services.

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