Revises provisions relating to pharmacy benefit managers. (BDR 57-534)

S.B. 209

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SENATE BILL NO. 209–SENATORS STONE, NGUYEN,
STEINBECK, ELLISON, KRASNER; AND BUCK

FEBRUARY 18, 2025
____________

Referred to Committee on Commerce and Labor

SUMMARY—Revises provisions relating to pharmacy benefit
managers. (BDR 57-534)

FISCAL NOTE: Effect on Local Government: May Have Fiscal Impact.
Effect on the State: Yes.

CONTAINS UNFUNDED MANDATE (§ 36)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)

~

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

AN ACT relating to pharmacy benefit managers; expanding the
scope of certain provisions; prohibiting pharmacy benefit
managers from engag ing in certain practices; requiring
pharmacy benefit managers to make certain disclosures;
requiring pharmacy benefit managers to pass rebates
along to certain insurers and insureds; requiring pharmacy
benefit managers and the Commissioner of Insurance to
prepare certain reports; providing a cause of action for
certain pharmacies; requiring certain insurers to use
passed-along rebate funds for certain purposes; providing
penalties; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Existing law requires a pharmacy benefit manager to obtain a certificate of 1
registration as an insurance administrator from the Commissioner of Insurance and 2
comply with the requirements that apply to insurance administrators generally. 3
(NRS 683A .025, 683A.08522 -683A.0893) Existing law additionally imposes 4
certain requirements specifically regulating the operation of pharmacy benefit 5
managers, which are entities that manage pharmacy benefits plans. (NRS 6
683A.171-683A.179) Existing law defines “pha rmacy benefits plan” to refer to 7
insurance coverage of prescription drugs. (NRS 683A.175) Section 19 of this bill 8
expands the scope of that definition to also refer to ins urance coverage of 9
pharmacist services. Section 19 thereby expands the scope of provisions governing 10
pharmacy benefit managers to also apply to entities that manage such coverage. 11

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Sections 2-13 of this bill define certain other terms relevant to pharmacy benefit 12
managers, and section 18 of th is bill establishes the applicability of those 13
definitions. Section 14 of this bill prohibits a pharmacy benefit manager that 14
manages a plan which provides coverage throug h a network from requiring a 15
person to use a pharmacy affiliated with the pharmacy benefit manager if there are 16
other, nonaffiliated pharmacies in the network. Section 14 additionally prohibits a 17
pharmacy benefit manager from engaging in certain practices which are intended or 18
have the effect of steering a person towards an affiliated pharmacy instead of a 19
nonaffiliated pharmacy in the network. Section 14 also prohibits a pharmacy 20
benefit manager from discriminating against a nonaffiliated pharmacy. Section 15 21
of this bill requires a pharmacy benefit manager to disclose to a third party insurer 22
for which the pharmacy benefit manager manages a pharmacy benefits plan the 23
amount and types of fees that the pharmacy benefit manager charges the third party 24
for managing the plan or otherwise receives from other entities, including rebates, 25
in connection with managing the plan. 26
Existing law authorizes the Department of Health and Human Services to enter 27
into a contract with a pharmacy benefit manager to manage cover age of 28
prescription drugs under the State Plan for Medicaid and the Children’s Health 29
Insurance Program that requires the pharmacy benefit manager to provide to the 30
Department all rebates received for purchasing drugs in relation to those programs. 31
(NRS 42 2.4053) Section 15 imposes similar requirements for pharmacy benefit 32
managers that manage other pharmacy benefits plans. Specifically, section 15 33
requires a pharmacy benefit manager to provide the entire amount of any rebate the 34
pharmacy benefit manager receives in connection with providing pharmacy benefit 35
management services for a third party insurer that provides pharmacy coverage to: 36
(1) persons covered by the third party; or (2) the third party. Sections 22, 24-29, 32, 37
33, 36 and 37 of this bill req uire certain third parties that provide coverage for 38
prescription drugs to use any rebate money received from a pharmacy benefit 39
manager pursuant to section 15 for the sole purpose of reducing premiums and 40
eliminating or reducing cost -sharing obligations of covered persons. Section 23 of 41
this bill authorizes the Commissioner to require a domestic insurer that issues a 42
policy of individual health insurance to a person residing in another state to meet 43
the requirements of section 22 in certain circumstances. Sections 30 and 34 of this 44
bill indicate that the requirement governing t he use of rebates received from a 45
pharmacy benefit manager is inapplicable to a managed care organization that is 46
providing coverage to recipients of Medicaid. Section 31 of this bill authorizes the 47
Commissioner to suspend or revoke the certificate of a health maintenance 48
organization that fails to comply with the requirements of section 29. The 49
Commissioner would also be authorized to take such action against other health 50
insurers who fail to comply with the requirements of sections 22, 24-28, 32 and 33. 51
(NRS 680A.200) 52
Section 16 of this bill prohibits a pharmacy benefit manager from: (1) using 53
spread pricing, which is a technique by which a pharmacy benefit manager charges 54
a third party an amount for a prescription drug that is different from the amount that 55
the pharmacy benefit manager reimburses a pharmacy for the same drug; (2) 56
agreeing to exclusively cover certain drugs; and (3) making or disseminating a false 57
or misleading statement or advertisement. Section 21 of this bill additionally 58
prohibits a pharmacy benefit manager from engaging in certain practices while 59
doing business with pharmacies. Section 21 also authorizes a pharmacy to bring an 60
action to recover certain damages against a pharmacy benefit manager that 61
retaliates against the pharmacy for reporting or attempt ing to remedy a potential or 62
actual violation of law applicable to insurance by the pharmacy benefit manager. 63
Section 17 of this bill requires a pharmacy benefit manager to submit to the 64
Commissioner an annual report detailing certain business practices of the pharmacy 65
benefit manager as well as certain information regarding pricing and rebates 66

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relating to the prescription drugs administered by the pharmacy benefit manage r. 67
Sections 17 and 35 of this bill provide for the confidentiality of the information 68
contained in the report. Section 17 requires the Commissioner to compile, submit 69
to the Legislature and publish on the I nternet a report once every 2 years on the 70
overall impact of pharmacy benefit managers on the cost of prescription drugs in 71
this State based on the reports submitted by the pharmacy benefit managers. 72
Existing law exempts certain federally regulated insura nce coverage of 73
prescription drugs provided by employers for their employees from requirements 74
governing pharmacy benefit managers except where the pharmacy benefit manager 75
is required by contract to comply with those requirements. (NRS 683A.177) In 76
Rutledge v. Pharm. Care Mgmt. Ass’n , the United States Supreme Court held that 77
states are authorized to impose certain general requirements governing pharmacy 78
benefit managers on pharmacy benefit managers that manage such coverage. (592 79
U.S. 80, 89 (2020)) Section 20 of this bill removes the exemption for such 80
coverage from certain requirements governing pharmacy benefit managers, thereby 81
requiring a pharmacy benefit manager tha t manages such coverage to comply with 82
those requirements. Section 20 also subjects a pharmacy benefit manager that 83
manages such coverage to the requirements of this bill , to the extent authorized by 84
current precedent of the United States Supreme Court. 85

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

Section 1. Chapter 683A of NRS is hereby amended by 1
adding thereto the provisions set forth as sections 2 to 17, inclusive, 2
of this act. 3
Sec. 2. “Affiliated pharmacy” means a pharmacy that 4
directly, or indirectly through one or more intermediaries, 5
controls, is controlled by or is under common control with a 6
pharmacy benefit manager. 7
Sec. 3. “Claim” means a request for payment for: 8
1. Administering, filling or refilling a prescription drug; or 9
2. Providing a pharmacist service or a medical supply or 10
device to a covered person. 11
Sec. 4. “Control” has the meaning ascribed to it in 12
NRS 692C.050. 13
Sec. 5. “Cost-sharing obligation” includes, without 14
limitation, a copayment, coinsurance or deductible imposed upon 15
or collected from a covered person in connection with filling a 16
prescription or obtaining other pharmacist services. 17
Sec. 6. “Manufacturer” has the meaning ascribed to it in 42 18
U.S.C. § 1396r-8(k)(5). 19
Sec. 7. “Network plan” means a pharmacy benefits plan 20
offered by a third party und er which the financing and delivery of 21
pharmacist services is provided, in whole or in part, through a 22
defined set of providers under contract with the third party. The 23
term does not include an arrangement for the financing of 24
premiums. 25

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Sec. 8. “Nonaffiliated pharmacy” means a pharmacy that: 1
1. Directly or indirectly through a pharmacy services 2
administrative organization contracts with a pharmacy benefit 3
manager; and 4
2. Does not control, is not controlled by and is not under 5
common control with the pharmacy benefit manager. 6
Sec. 9. “Pharmacist services” means the provision of 7
products, goods or services , or any combination thereof, provided 8
as a part of the practice of pharmacy, as defined in NRS 639.0124. 9
Sec. 10. “Pharmacy benefit management services” includes, 10
without limitation: 11
1. Negotiating the price of prescripti on drugs, including, 12
without limitation, negotiating or contracting for direct or indirect 13
rebates, discounts or price concessions on prescription drugs. 14
2. Managing any aspect of a pharmacy benefits plan, 15
including, without limitation: 16
(a) Developing or managing a formulary; 17
(b) Processing and paying claims for prescription drugs; 18
(c) Performing reviews of the utilization of prescription drugs; 19
(d) Processing requests for prior authorization for 20
prescriptions; 21
(e) Adjudicating appeals and grievances relating to a 22
pharmacy benefits plan; 23
(f) Contracting with pharmacies to provide pharmacist services 24
for covered persons; 25
(g) Managing the cost of covered prescription drugs on behalf 26
of a third party; and 27
(h) Managing or providing data relating to a p harmacy 28
benefits plan. 29
3. Performing any administrative, managerial, clinical, 30
pricing, financial, reimbursement, data administration, reporting 31
or billing service for a third party in relation to a pharmacy 32
benefits plan. 33
Sec. 11. “Pharmacy services administrative organization” 34
means an entity that provides contracting and other administrative 35
services relating to prescription drug benefits to pharmacies. 36
Sec. 12. “Rebate” means any discou nt, remuneration or 37
other payment paid by a manufacturer or wholesaler to a 38
pharmacy benefit manager after a claim has been adjudicated or 39
completed at a pharmacy. The term d oes not include a bona fide 40
service fee, as defined in 42 C.F.R. § 447.502. 41
Sec. 13. “Wholesaler” has the meaning ascribed to it in 42
NRS 639.016. 43
Sec. 14. 1. A pharmacy benefit manager that manages a 44
network plan shall not: 45

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(a) Require a covered person to use an affiliated pharmacy to 1
fill a prescription or obtain other pharmacist services if there is a 2
nonaffiliated pharmacy in the network; 3
(b) Except as authorized by subsection 2, induce, persuade or 4
attempt to induce or persuade a covered person to transfer a 5
prescription to or otherwise use an affiliated pharmacy instead of 6
a nonaffiliated pharmacy in the network; 7
(c) Unreasonably restrict a covered person from using a 8
particular pharmacy in the network for the purpose of filling a 9
prescription or receiving p harmacist services covered by the 10
pharmacy benefits plan of the covered person; 11
(d) Communicate to a covered person that the covered person 12
is required to have a prescription filled or receive other pharmacist 13
services at a particular pharmacy if there ar e other pharmacies in 14
the network that have the ability to dispense the prescription or 15
provide the pharmacist services required by the covered person; 16
(e) Unreasonably obstruct or interfere with the ability of a 17
covered person to timely access a prescrip tion drug or device that 18
has been prescribed to the covered person at a pharmacy of the 19
person’s choice, including, without limitation, a nonaffiliated 20
pharmacy; 21
(f) Discriminate against a nonaffiliated pharmacy based on the 22
nonaffiliated status of the pharmacy, including, without limitation, 23
by: 24
(1) Offering materially different terms or conditions to a 25
nonaffiliated pharmacy based on the status as a nonaffiliated 26
pharmacy; 27
(2) Refusing to renew or terminating a contract with a 28
nonaffiliated pharmacy on the basis that the pharmacy is a 29
nonaffiliated pharmacy, or for reasons other than those that apply 30
equally to affiliated pharmacies; and 31
(3) Reimbursing a nonaffiliated pharmacy for a pharmacist 32
service in an amount that is less than the pharmacy ben efit 33
manager would reimburse an affiliated pharmacy for the same 34
pharmacist service; or 35
(g) Deny a pharmacy the opportunity to participate in a 36
network or receive a preferred status if the pharmacy is willing to 37
accept the same terms and conditions that t he pharmacy benefit 38
manager has established for affiliated pharmacies as a condition 39
for participating in the network or receiving preferred status, as 40
applicable. 41
2. A third party or pharmacy benefit manager may reduce the 42
amount of an applicable cost -sharing obligation of a covered 43
person who fills a prescription or obtains other pharmacist 44
services at a particular pharmacy. The third party or pharmacy 45

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benefit manager must reduce the cost -sharing obligation to an 1
amount that is less than the cost -sharing obligation that the 2
covered person would otherwise pay to fill the same prescription or 3
obtain the same pharmacist services at any other pharmacy in the 4
network under the terms of the applicable pharmacy benefits plan. 5
3. As used in this section, “netw ork” means a defined set of 6
pharmacies that are under contract to provide pharmacist services 7
pursuant to a network plan. 8
Sec. 15. A pharmacy benefit manager shall: 9
1. Upon the request of a third party for which the pharm acy 10
benefit manager manages a pharmacy benefits plan, disclose to 11
the third party, in writing, the amounts and types of charges, fees 12
and commissions that the pharmacy benefit manager charges the 13
third party for providing pharmacy benefit management servic es 14
or otherwise receives in connection with managing the pharmacy 15
benefits plan of the third party, including, without limitation, 16
administrative fees and rebates collected from manufacturers and 17
wholesalers. 18
2. Except as otherwise provided in NRS 422.40 53, transmit 19
the entire amount of any rebate received from a manufacturer or 20
wholesaler in connection with providing pharmacy benefit 21
management services for a third party in the following order of 22
priority: 23
(a) To the covered person who receives the drug to which the 24
rebate pertains by directly transmitting the rebate, or an equivalent 25
credit, to the pharmacy that dispenses the drug to be applied at the 26
point-of-sale for the purpose of offsetting or reducing the cost -27
sharing obligation of the covered person. 28
(b) To the third party. 29
Sec. 16. 1. A pharmacy benefit manager shall not: 30
(a) Use spread pricing. 31
(b) Enter into, amend, enforce or renew a contract with a 32
manufacturer that expressly or implicitly provides for the 33
exclusive coverage of a drug, medical device or other product by a 34
pharmacy benefits plan or group of pharmacy benefits plans. 35
(c) Make or disseminate any statement, representation or 36
advertisement that is, or reasonably should be known to be, 37
untrue, deceptive or misleading. 38
2. As used in this section, “spread pricing” means any 39
technique by which a pharmacy benefit manager charges or 40
claims an amount from a third party for services provided by a 41
pharmacy or pharmacist that is different from the amou nt the 42
pharmacy benefit manager pays the pharmacy or pharmacist, as 43
applicable, for those services. 44

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Sec. 17. 1. On or before April 1 of each year, a pharmacy 1
benefit manager shall submit to the Commissioner: 2
(a) A report which includes the information prescribed by 3
subsection 2; and 4
(b) A statement signed under the penalty of perjury affirming 5
the accuracy of the information in the report. 6
2. The report submitted pursuant to paragraph (a) of 7
subsection 1 must include: 8
(a) Lists of: 9
(1) The 50 prescription drugs with the highest wholesale 10
acquisition costs at the time the report is submitted; 11
(2) The 50 prescription drugs most frequently prescribed to 12
covered persons in this State during the immediately preceding 13
calendar year; and 14
(3) The 50 prescription drugs which produce d the largest 15
amount of revenue for the pharmacy benefit manager in this State 16
during the immediately preceding calendar year. 17
(b) For each prescription for a drug included on a list 18
compiled pursuant to paragraph (a) that was issued to a covered 19
person within the immediately preceding year: 20
(1) The type of pharmacy that filled the prescription. The 21
type of pharmacy may be an integrated pharmacy, chain 22
pharmacy, specialty pharmacy, mail order pharmacy or other type 23
of pharmacy. 24
(2) Information relating to pricing of and rebates for the 25
drug, including, without limitation: 26
(I) The total amount that the pharmacy benefit manager 27
paid to the pharmacy for filling the prescription; 28
(II) The net amount that the pharmacy benefit manager 29
paid to the pharmacy for filling the prescription, after accounting 30
for any fees or assessments imposed by the pharmacy benefit 31
manager against the pharmacy; 32
(III) The amount of any rebate negotiated by the 33
pharmacy benefit manager with the manufacturer for the 34
purchase of the drug; 35
(IV) The amount of any rebate described in sub -36
subparagraph (III) that was passed on to either the applicable 37
third party or the covered person; and 38
(V) The amount that the a pplicable third party paid the 39
pharmacy benefit manager for the drug. 40
(c) Information prescribed by regulation of the Commissioner 41
that allows the Commissioner to determine whether each claim for 42
a prescription drug included on a list compiled pursuant to 43
paragraph (a) required prior authorization. Such information 44
must be in deidentified form. 45

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(d) For each prescription drug appearing on a list compiled 1
pursuant to paragraph (a), the aggregate amount for the 2
immediately preceding year of the: 3
(1) Cost o f the drug, based on the total units of the drug 4
dispensed to covered persons in this State multiplied by the 5
wholesale acquisition cost of the drug at the time each unit was 6
dispensed; 7
(2) Amount of rebates negotiated for the purchase of the 8
drug in this State; 9
(3) Amount of administrative fees received from a 10
manufacturer or wholesaler for services provided in this State 11
relating to the drug; 12
(4) Amount paid or reimbursed to affiliated pharmacies in 13
this State for the drug; and 14
(5) Amount paid or reimbursed to nonaffiliated pharmacies 15
in this State for the drug. 16
(e) A list of the third parties with which the pharmacy benefit 17
manager has contracted, the scope of services provided to each 18
third party and the number of persons covered in this State b y 19
each third party listed. 20
(f) The total amount of revenue derived from providing 21
pharmacy benefit management services in this State in the 22
immediately preceding year. 23
(g) The expenses incurred by providing pharmacy benefit 24
management services in this St ate in the immediately preceding 25
year. 26
(h) The identity of each group purchasing organization 27
employed, contracted or otherwise utilized by or affiliated with the 28
pharmacy benefit manager. 29
(i) A copy of each contract entered into with a group 30
purchasing organization identified pursuant to paragraph (h). 31
(j) The aggregate financial benefit derived in the immediately 32
preceding year from the use of the group purchasing 33
organizations identified pursuant to paragraph (h). 34
(k) A list of the types and amounts of fees that the pharmacy 35
benefit manager has collected during the immediately preceding 36
year for performing pharmacy benefit management services in this 37
State and a description of how those fees are calculated. 38
(l) A copy of all fee agreements entered in to with third parties, 39
pharmacies and pharmacy services administrative organizations 40
doing business in this State. 41
(m) The amount of each premium, deductible, cost -sharing 42
obligation or fee charged by the pharmacy benefit manager to 43
covered persons in thi s State or other persons on behalf of such 44
covered persons. 45

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3. On or before July 1 of each even -numbered year, the 1
Commissioner shall: 2
(a) Compile a report on the overall impact of pharmacy benefit 3
managers on the cost of prescription drugs in this Stat e based on 4
the reports submitted to the Commissioner pursuant to subsection 5
1. The data in the report compiled pursuant to this subsection 6
must be in aggregated form and must not reveal specific 7
information concerning an individual purchaser or manufacture r 8
of a drug, including, without limitation, information relating to a 9
manufacturer’s individual or aggregate discounted prices. 10
(b) Submit the report to the Director of the Legislative Counsel 11
Bureau for transmittal to the Joint Interim Standing Committee 12
on Health and Human Services and the Joint Interim Standing 13
Committee on Commerce and Labor. 14
(c) Present the report at a meeting of the Joint Interim 15
Standing Committee on Health and Human Services. 16
(d) Post the report on an Internet website operated by the 17
Division. 18
4. Except as otherwise provided in subsection 3, any 19
information submitted by a pharmacy benefit manager pursuant to 20
this section is confidential and is not a public record. 21
5. Nothing in this section shall be construed to impose any 22
recordkeeping obligation on a third party for which a pharmacy 23
benefit manager manages a pharmacy benefits plan. 24
6. As used in this section: 25
(a) “Group purchasing organization” means a person 26
employed, contracted or otherwise utilized by or affiliated with a 27
pharmacy benefit manager to negotiate, obtain or procure rebates 28
from manufacturers or wholesalers. 29
(b) “National Drug Code” means the numerical code assigned 30
to a prescription drug by the United States Food and Drug 31
Administration. 32
(c) “Wholesale acq uisition cost” means the manufacturer’s 33
published list price for a prescription drug with a unique National 34
Drug Code for sale to a wholesaler or any other purchaser or 35
entity that purchases the prescription drug from the manufacturer, 36
not including any rebates or other price concessions. 37
Sec. 18. NRS 683A.171 is hereby amended to read as follows: 38
683A.171 As used in NRS 683A.171 to 683A.179, inclusive, 39
and sections 2 to 17, inclusive, of this act, unless the context 40
otherwise requires, the words and terms defined in NRS 683A.172 41
to 683A.176, inclusive, and sections 2 to 13, inclusive, of this act 42
have the meanings ascribed to them in those sections. 43

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Sec. 19. NRS 683A.175 is hereby amended to read as follows: 1
683A.175 “Pharmacy benefits plan” means coverage of 2
prescription drugs and pharmacist services provided by a third 3
party. 4
Sec. 20. NRS 683A.177 is hereby amended to read as follows: 5
683A.177 1. Except as otherwise provided in [subsection] 6
subsections 2 [,] and 3, the requirements of NRS 683A.171 to 7
683A.179, inclusive, and sections 2 to 17, inclusive, of this act and 8
any regulations adopted by the Commissioner pursuant thereto do 9
not apply to the coverage of prescription drugs under a plan that is 10
subject to the Employee Retirement Income Security Act of 1974 or 11
any information relating to such coverage. 12
2. Except as otherwise provided in this subsection, the 13
provisions of NRS 68 3A.179, except for paragraph (d) of 14
subsection 1 of NRS 683A.179, section 15 of this act, except for 15
paragraph (a) of subsection 2 of section 15 of this act , and 16
paragraphs (a) and (c) of subsection 1 of section 16 of this act 17
apply to the coverage of prescription drugs under a plan that is 18
subject to the Employee Retirement Income Security Act of 1974 19
or any information relat ing to such coverage. Except where 20
required pursuant to subsection 3, a pharmacy benefit manager is 21
not required to include in a report submitted pursuant to section 22
17 of this act any information: 23
(a) Derived from data relating to claims administered or 24
coverage provided under such a plan; or 25
(b) Specifically relating to or that otherwise reveals the details 26
of the administration of such a plan. 27
[2.] 3. A plan described in subsection 1 may, by contract, 28
require a pharmacy benefit manager that manages the coverage of 29
prescription drugs under the plan to comply with the requirements 30
of NRS 683A.171 to 683A.179 , inclusive, and sections 2 to 17, 31
inclusive, of this act and any regulations adopted by the 32
Commissioner pursuant thereto. 33
Sec. 21. NRS 683A.179 is hereby amended to read as follows: 34
683A.179 1. A pharmacy benefit manager shall not: 35
(a) Prohibit a pharmacist or pharmacy from providing 36
information to a covered person concerning: 37
(1) The amount of any copayment or coinsurance for a 38
prescription drug; or 39
(2) The availability of a less expensive alternative or generic 40
drug including, without limitation, information concerning clinical 41
efficacy of such a drug; 42
(b) Penalize a pharmacist or pharmacy for providing the 43
information described in paragraph (a) or selling a less expensive 44
alternative or generic drug to a covered person; 45

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(c) Prohibit a pharmacy from offering or providing delivery 1
services directly to a covere d person as an ancillary service of the 2
pharmacy; [or] 3
(d) If the pharmacy benefit manager manages a pharmacy 4
benefits plan that provides coverage through a network plan, charge 5
a copayment or coinsurance for a prescription drug in an amount 6
that is greater than the total amount paid to a pharmacy that is in the 7
network of providers under contract with the third party [.] ; 8
(e) Restrict, by contract or otherwise, the ability of a pharmacy 9
to share or disclose the details of a contract between the pharmacy 10
and the pharmacy benefit manager with a trade organization for 11
pharmacies or the Commissioner; 12
(f) Reimburse a pharmacy for a prescription drug in an 13
amount that is less than the pharmacy pays a wholesaler for the 14
prescription drug, as reflected on the i nvoice provided by the 15
wholesaler to the pharmacy; 16
(g) Directly or indirectly reduce or allow the reduction of any 17
payment to a pharmacy under a pharmacy benefits plan managed 18
by the pharmacy benefit manager under a reconciliation process 19
to an effective rate of reimbursement; 20
(h) Directly or indirectly retroactively reduce or deny a claim 21
after the claim has been adjudicated unless: 22
(1) The original claim is fraudulent; 23
(2) The original payment of the claim was incorrect 24
because the pharmacy or pharmacist had already been paid for the 25
pharmacist services to which the claim relates; or 26
(3) The pharmacy or pharmacist that submitted the claim 27
did not properly render the pharmacist services to which the claim 28
relates; 29
(i) Reverse and resubmit the claim of a pharmacy: 30
(1) Without notifying and attempting to reconcile the claim 31
with the pharmacy; or 32
(2) More than 90 days after the claim was first affirmatively 33
adjudicated; 34
(j) Charge a pharmacy or a pharmacist a fee to process a claim 35
electronically; 36
(k) Refuse to pay a claim after terminating a contract with a 37
pharmacy, except where the pharmacy benefit manager is 38
investigating possible insurance fraud; or 39
(l) Retaliate against a pharmacy for reporting a potential or 40
actual violation of this title or attempting to settle a dispute with a 41
pharmacy benefit manager based on a potential or actual violation 42
of this title. 43
2. The provisions of this section: 44

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(a) Must not be construed to authorize a pharmacist to dispense 1
a drug that has not been prescri bed by a practitioner, as defined in 2
NRS 639.0125, except to the extent authorized by a specific 3
provision of law, including, without limitation, NRS 453C.120, 4
639.28078 and 639.28085. 5
(b) Do not apply to an institutional pharmacy, as defined in NRS 6
639.0085, or a pharmacist working in such a pharmacy as an 7
employee or independent contractor. 8
3. Any provision of a contract that restricts the ability of a 9
pharmacy to share information pursuant to paragraph (e) of 10
subsection 1 is against public policy, void and unenforceable. 11
4. A pharmacy may bring an action for statutory damages 12
against a pharmacy benefit manager who retaliates against the 13
pharmacy in violation of paragraph (l) of subsection 1. If the 14
pharmacy prevails in such an action, the court shall award 15
the pharmacy $5,000 for each violation, in addition to attorney ’s 16
fees and costs. 17
5. As used in this section , [“network plan” means a health 18
benefit plan offered by a health carrier under which the financing 19
and delivery of medical care is provide d, in whole or in part, 20
through a defined set of providers under contract with the carrier. 21
The term does not include an arrangement for the financing of 22
premiums.] “retaliate” includes, without limitation: 23
(a) Terminating or refusing to renew a contract with a 24
pharmacy. 25
(b) Making the renewal of a contract with a pharmacy 26
contingent on the pharmacy acceding to terms and conditions not 27
applicable to other pharmacies. 28
(c) Subjecting the pharmacy to increased audits. 29
(d) Failing to promptly pay or reimbur se a pharmacy without 30
substantial justification. 31
Sec. 22. Chapter 689A of NRS is hereby amended by adding 32
thereto a new section to read as follows: 33
1. An insurer that uses a pharmacy benefit manager to 34
manage coverage of prescription drugs included in a policy of 35
health insurance shall use any money received from the pharmacy 36
benefit manager pursuant to section 15 of this act for the sole 37
purpose of reducing premiums and offsetting or reducing cost -38
sharing obligations of insureds. 39
2. As used in this section: 40
(a) “Cost-sharing obligation” has the meaning ascribed to it in 41
section 5 of this act. 42
(b) “Pharmacy benefit manager” has the meaning ascribed to 43
it in NRS 683A.174. 44

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Sec. 23. NRS 689A.330 is hereby amended to read as follows: 1
689A.330 If any policy is issued by a domestic insurer for 2
delivery to a person residing in another state, and if the insurance 3
commissioner or corresponding public officer of that other state has 4
informed the Commissioner that the policy is not subject to approval 5
or disapproval by that officer, the Commissioner may by ruling 6
require that the policy meet the standards set forth in NRS 689A.030 7
to 689A.320, inclusive [.] , and section 22 of this act. 8
Sec. 24. Chapter 689B of NRS is hereby amended by adding 9
thereto a new section to read as follows: 10
1. An insurer that uses a pharmacy benefit manager to 11
manage coverage of prescription drugs included in a policy of 12
group health insurance shall use any money received from the 13
pharmacy benefit manager pursuant to section 15 of this act for 14
the sole purpose of reducing premiums and offsetting or reducing 15
cost-sharing obligations of insureds. 16
2. As used in this section: 17
(a) “Cost-sharing obligation” has the meaning ascribed to it in 18
section 5 of this act. 19
(b) “Pharmacy benefit manager” has the meaning ascribed to 20
it in NRS 683A.174. 21
Sec. 25. Chapter 689C of N RS is hereby amended by adding 22
thereto a new section to read as follows: 23
1. A carrier that uses a pharmacy benefit manager to manage 24
coverage of prescription drugs included in a health benefit plan 25
shall use any money received from the pharmacy benefit m anager 26
pursuant to section 15 of this act for the sole purpose of reducing 27
premiums and offsetting or reducing cost -sharing obligations of 28
insureds. 29
2. As used in this section: 30
(a) “Cost-sharing obligation” has the meaning ascribed to it in 31
section 5 of this act. 32
(b) “Pharmacy benefit manager” has the m eaning ascribed to 33
it in NRS 683A.174. 34
Sec. 26. NRS 689C.425 is hereby amended to read as follows: 35
689C.425 A voluntary purchasing group and any contract 36
issued to such a group pursuant to NRS 689C.360 to 689C.600, 37
inclusive, are subject to the provisions of NRS 689C.015 to 38
689C.355, inclusive, and section 25 of this act, to the extent 39
applicable and not in conflict with the express provisions of NRS 40
687B.408 and 689C.360 to 689C.600, inclusive. 41
Sec. 27. Chapter 695A of NRS is hereby amended by adding 42
thereto a new section to read as follows: 43
1. A society that uses a pharmacy benefit manager to manage 44
coverage of prescription drugs included in a benefit contract shall 45

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use any money received from the pharmacy benefit manager 1
pursuant to section 15 of this act for the sole purpose of reducing 2
premiums and offsetting or reducing cost -sharing obligations of 3
insureds. 4
2. As used in this section: 5
(a) “Cost-sharing obligation” has the meaning ascribed to it in 6
section 5 of this act. 7
(b) “Pharmacy benefit manager” has the meaning ascribed to 8
it in NRS 683A.174. 9
Sec. 28. Chapter 695B of N RS is hereby amended by adding 10
thereto a new section to read as follows: 11
1. A hospital or medical services corporation that uses a 12
pharmacy benefit manager to manage coverage of prescription 13
drugs included in a policy of health insurance shall use any 14
money received from the pharmacy benefit manager pursuant to 15
section 15 of this act for the sole purpose of reducing premiums 16
and offsetting or reducing cost-sharing obligations of insureds. 17
2. As used in this section: 18
(a) “Cost-sharing obligation” has the meaning ascribed to it in 19
section 5 of this act. 20
(b) “Pharmacy benefit manager” has the meaning ascribed to 21
it in NRS 683A.174. 22
Sec. 29. Chapter 695C of NRS is hereby amended by adding 23
thereto a new section to read as follows: 24
1. A health maintenance organization that uses a pharmacy 25
benefit manager to manage coverage of prescription drugs 26
included in a health care plan shall use any money received from 27
the pharmacy benefit manager pursuant to section 15 of this act 28
for the sole purpose of reducing premiums and offsetting or 29
reducing cost-sharing obligations of enrollees. 30
2. As used in this section: 31
(a) “Cost-sharing obligation” has the meaning ascribed to it in 32
section 5 of this act. 33
(b) “Pharmacy benefit manager” has the meaning ascribed to 34
it in NRS 683A.174. 35
Sec. 30. NRS 695C.050 is hereby amended to read as follows: 36
695C.050 1. Except as otherwise provided in this chapter or 37
in specific provisions of this title, the provisions of this title are not 38
applicable to any health maintenance organization granted a 39
certificate of authority under this chapter. This provision does not 40
apply to an insurer licensed and regulated pursuant to this title 41
except with respect to its activities as a health maintenance 42
organization authorized and regulated pursuant to this chapter. 43
2. Solicitation of enrollees by a health maintenance 44
organization granted a certificate of authority, or its representatives, 45

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must not be construed to violate any provision of law relating to 1
solicitation or advertising by practitioners of a healing art. 2
3. Any health maintenance organization authorized under this 3
chapter shall not be deemed to be practicing medicine and is exempt 4
from the provisions of chapter 630 of NRS. 5
4. The provisions of NRS 695C.110, 695C .125, 695C.1691, 6
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 7
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 8
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 9
inclusive, and 695C.265 and section 29 of this act do not apply to a 10
health maintenance organization that provides health care services 11
through managed care to recipients of Medicaid under the State Plan 12
for Medicaid or insuran ce pursuant to the Children’s Health 13
Insurance Program pursuant to a contract with the Division of 14
Health Care Financing and Policy of the Department of Health and 15
Human Services. This subsection does not exempt a health 16
maintenance organization from any p rovision of this chapter for 17
services provided pursuant to any other contract. 18
5. The provisions of NRS 695C.16932 to 695C.1699, 19
inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 20
695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, 21
inclusive, 695C.1757 and 695C.204 apply to a health maintenance 22
organization that provides health care services through managed 23
care to recipients of Medicaid under the State Plan for Medicaid. 24
6. The provisions of NRS 695C.17095 do not apply to a health 25
maintenance organization that provides health care services to 26
members of the Public Employees’ Benefits Program. This 27
subsection does not exempt a health maintenance organization from 28
any provision of this chapter for services provided pursuant to any 29
other contract. 30
7. The provisions of NRS 695C.1735 do not apply to a health 31
maintenance organization that provides health care services to: 32
(a) The officers and employees, and the dependents of officers 33
and employees, of the governing body of any county, school district, 34
municipal corporation, political subdivision, public corporation or 35
other local governmental agency of this State; or 36
(b) Members of the Public Employees’ Benefits Program. 37
 This subsection does not exempt a health maintenance 38
organization from a ny provision of this chapter for services 39
provided pursuant to any other contract. 40
Sec. 31. NRS 695C.330 is hereby amended to read as follows: 41
695C.330 1. The Commissioner may suspend or revoke any 42
certificate of authority issued to a health maintenance organization 43
pursuant to the provisions of this chapter if the Commissioner finds 44
that any of the following conditions exist: 45

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(a) The health maintenance organization is operating 1
significantly in contravention of i ts basic organizational document, 2
its health care plan or in a manner contrary to that described in and 3
reasonably inferred from any other information submitted pursuant 4
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 5
to those submissions hav e been filed with and approved by the 6
Commissioner; 7
(b) The health maintenance organization issues evidence of 8
coverage or uses a schedule of charges for health care services 9
which do not comply with the requirements of NRS 695C.1691 to 10
695C.200, inclusive, and section 29 of this act or NRS 695C.204 or 11
695C.207; 12
(c) The health care plan does not furnish comprehensive health 13
care services as provided for in NRS 695C.060; 14
(d) The Commissioner certifies that the health maintenance 15
organization: 16
(1) Does not meet the requirements of subsection 1 of NRS 17
695C.080; or 18
(2) Is unable to fulfill its obligations to furnish health care 19
services as required under its health care plan; 20
(e) The health maintenance organization is no longer financially 21
responsible and may reasonably be expected to be unable to meet its 22
obligations to enrollees or prospective enrollees; 23
(f) The health maintenance organization has fail ed to put into 24
effect a mechanism affording the enrollees an opportunity to 25
participate in matters relating to the content of programs pursuant to 26
NRS 695C.110; 27
(g) The health maintenance organization has failed to put into 28
effect the system required by NRS 695C.260 for: 29
(1) Resolving complaints in a manner reasonably to dispose 30
of valid complaints; and 31
(2) Conducting external reviews of adverse determinations 32
that comply with the provisions of NRS 695G.241 to 695G.310, 33
inclusive; 34
(h) The health maint enance organization or any person on its 35
behalf has advertised or merchandised its services in an untrue, 36
misrepresentative, misleading, deceptive or unfair manner; 37
(i) The continued operation of the health maintenance 38
organization would be hazardous to i ts enrollees or creditors or to 39
the general public; 40
(j) The health maintenance organization fails to provide the 41
coverage required by NRS 695C.1691; or 42
(k) The health maintenance organization has otherwise failed to 43
comply substantially with the provisions of this chapter. 44

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2. A certificate of authority must be suspended or revoked only 1
after compliance with the requirements of NRS 695C.340. 2
3. If the certificate of authority of a health maintenance 3
organization is suspended, the health maintenance organization shall 4
not, during the period of that suspension, enroll any additional 5
groups or new individual contracts, unless those groups or persons 6
were contracted for before the date of suspension. 7
4. If the certificate of authority of a health maintenance 8
organization is revoked, the organization shall proceed, immediately 9
following the effective date of the order of revocation, to wind up its 10
affairs and shall conduct no further business except as may be 11
essential to the orderly conclusion of t he affairs of the organization. 12
It shall engage in no further advertising or solicitation of any kind. 13
The Commissioner may, by written order, permit such further 14
operation of the organization as the Commissioner may find to be in 15
the best interest of enro llees to the end that enrollees are afforded 16
the greatest practical opportunity to obtain continuing coverage for 17
health care. 18
Sec. 32. Chapter 695F of NRS is hereby amended by adding 19
thereto a new section to read as follows: 20
1. A prepaid limited health service organization that uses a 21
pharmacy benefit manager to manage coverage of prescription 22
drugs included in a limited health service shall use any money 23
received from the pharmacy benefit manager pursuant to section 24
15 of this act for the sole purpose of reducing premiums and 25
offsetting or reducing cost-sharing obligations of enrollees. 26
2. As used in this section: 27
(a) “Cost-sharing obligation” has the meaning ascribed to it in 28
section 5 of this act. 29
(b) “Pharmacy benefit manager” has the meaning ascribed to 30
it in NRS 683A.174. 31
Sec. 33. Chapter 695G of NRS is hereby amended by adding 32
thereto a new section to read as follows: 33
1. A managed care organization that uses a pharmacy benefit 34
manager to manage coverage of prescription drugs in cluded in a 35
health care plan shall use any money received from the pharmacy 36
benefit manager pursuant to section 15 of this act for the sole 37
purpose of redu cing premiums and offsetting or reducing cost -38
sharing obligations of insureds. 39
2. As used in this section: 40
(a) “Cost-sharing obligation” has the meaning ascribed to it in 41
section 5 of this act. 42
(b) “Pharmacy benefit manager” has the meaning ascribed to 43
it in NRS 683A.174. 44

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- *SB209*
Sec. 34. NRS 695G.090 is hereby amended to read as follows: 1
695G.090 1. Except as otherwise provided in subsection 3, 2
the provisions of this chapter apply to each organization and insurer 3
that operates as a managed care organization and may include, 4
without limitation, an insurer that issues a policy of health 5
insurance, an insurer that issues a policy of individual or group 6
health insurance, a carrier serving small employers, a fraternal 7
benefit society, a hospital or medical service corporation and a 8
health maintenance organization. 9
2. In addition to the provisions of this chapter, each manage d 10
care organization shall comply with: 11
(a) The provisions of chapter 686A of NRS, including all 12
obligations and remedies set forth therein; and 13
(b) Any other applicable provision of this title. 14
3. The provisions of NRS 695G.127, 695G.1639, 695G.164, 15
695G.1645, 695G.167 and 695G.200 to 695G.230, inclusive, and 16
section 33 of this act do not apply to a managed care organization 17
that provides health care services to recipients of Medicaid under 18
the State Plan for Medicaid or insurance pursuant to the Children’s 19
Health Insurance Program pursuant to a contract with the Division 20
of Health Care Financing and Policy of the Department of Health 21
and Human Services. 22
4. The provisions of NRS 695C.1735 and 695G.1639 do not 23
apply to a managed care organization that provides health care 24
services to members of the Public Employees’ Benefits Program. 25
5. Subsections 3 and 4 do not exempt a managed care 26
organization from any provision of this chapter for services 27
provided pursuant to any other contract. 28
Sec. 35. NRS 239.010 is hereby amended to read as follows: 29
239.010 1. Except as otherwise provided in this section and 30
NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 31
49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 32
62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 33
80.113, 81.850 , 82.183, 86.246, 86.54615, 87.515, 87.5413, 34
87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 35
88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 36
116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 37
119A.280, 119A.653, 119A.677, 1 19B.370, 119B.382, 120A.640, 38
120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 39
127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 40
130.712, 136.050, 159.044, 159A.044, 164.041, 172.075, 172.245, 41
176.01334, 176.01385, 176.015, 176 .0625, 176.09129, 176.156, 42
176A.630, 178.39801, 178.4715, 178.5691, 178.5717, 179.495, 43
179A.070, 179A.165, 179D.160, 180.600, 200.3771, 200.3772, 44
200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 45

– 19 –

- *SB209*
209.3925, 209.419, 209.429, 209.521, 211A.140, 213.0 10, 213.040, 1
213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 2
218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 218G.615, 3
224.240, 226.462, 226.796, 228.270, 228.450, 228.495, 228.570, 4
231.069, 231.1285, 231.1473, 232.1369, 233.190, 237.300, 5
239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 6
239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 7
239C.420, 240.007, 241.020, 241.030, 241.039, 242.105, 244.264, 8
244.335, 247.540, 247.545, 247.550, 247.560, 250.087, 250.130, 9
250.140, 250.145, 250.150, 268.095, 268.0978, 268.490, 268.910, 10
269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 11
281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 284.4086, 12
286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 13
293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 14
293.906, 293.908, 293.909, 293.910, 293B.135, 293D.510, 331.110, 15
332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 16
338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 17
353A.049, 353A.085, 353A .100, 353C.240, 353D.250, 360.240, 18
360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 19
366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 20
379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 21
387.631, 388.1455, 388.259, 388.50 1, 388.503, 388.513, 388.750, 22
388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 23
391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 24
392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 25
394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 26
396.159, 396.3295, 396.405, 396.525, 396.535, 396.9685, 27
398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 28
414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 29
425.400, 427A.1236, 427A.872, 427A.940, 432.028, 432.205, 30
432B.175, 432B.280, 432B.290, 432B.4018, 432B.407, 432B.430, 31
432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 32
439.4941, 439.4988, 439.5282, 439.840, 439.914, 439A.116, 33
439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 34
441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 35
442.774, 445A.665, 445B.570, 445B.7773, 449.209, 449.245, 36
449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 37
453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 38
459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 39
463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 40
481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 41
483.575, 483.659, 483.800, 484A.469, 484B.830, 484B.833, 42
484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 43
571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 44
598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 45

– 20 –

- *SB209*
604D.500, 604D.600, 612.265, 616B.012, 616B.015, 616B.315, 1
616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 2
624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 3
628B.760, 629.043, 629.047, 629.069, 630.133, 630.2671, 4
630.2672, 630.2673, 630.2687, 630.30665, 630.336, 630A.327, 5
630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 6
632.3423, 632.405, 633.283, 633.301, 633.427, 633.4715, 633.4716, 7
633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 8
634A.185, 634B.730, 635.111, 635.158, 636.262, 636.342, 637.085, 9
637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 10
639.2485, 639.570, 640.075, 640.1 52, 640A.185, 640A.220, 11
640B.405, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 12
640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 13
641.221, 641.2215, 641A.191, 641A.217, 641A.262, 641B.170, 14
641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D .320, 15
642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 16
645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 17
645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 18
648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 19
654.110, 65 6.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 20
669.285, 669A.310, 670B.680, 671.365, 671.415, 673.450, 673.480, 21
675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 22
678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 23
679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 24
681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 25
687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 26
688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 27
692C.3538, 692C.354, 692C.420, 69 3A.480, 693A.615, 696B.550, 28
696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 29
711.600, and section 17 of this act, sections 35, 38 and 41 of 30
chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, 31
Statutes of Nevada 2013 and unless otherwise declared by law to be 32
confidential, all public books and public records of a governmental 33
entity must be open at all times during office hours to ins pection by 34
any person, and may be fully copied or an abstract or memorandum 35
may be prepared from those public books and public records. Any 36
such copies, abstracts or memoranda may be used to supply the 37
general public with copies, abstracts or memoranda of the records or 38
may be used in any other way to the advantage of the governmental 39
entity or of the general public. This section does not supersede or in 40
any manner affect the federal laws governing copyrights or enlarge, 41
diminish or affect in any other mann er the rights of a person in any 42
written book or record which is copyrighted pursuant to federal law. 43
2. A governmental entity may not reject a book or record 44
which is copyrighted solely because it is copyrighted. 45

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3. A governmental entity that has legal custody or control of a 1
public book or record shall not deny a request made pursuant to 2
subsection 1 to inspect or copy or receive a copy of a public book or 3
record on the basis that the requested public book or record contains 4
information that is co nfidential if the governmental entity can 5
redact, delete, conceal or separate, including, without limitation, 6
electronically, the confidential information from the information 7
included in the public book or record that is not otherwise 8
confidential. 9
4. If requested, a governmental entity shall provide a copy of a 10
public record in an electronic format by means of an electronic 11
medium. Nothing in this subsection requires a governmental entity 12
to provide a copy of a public record in an electronic format or by 13
means of an electronic medium if: 14
(a) The public record: 15
(1) Was not created or prepared in an electronic format; and 16
(2) Is not available in an electronic format; or 17
(b) Providing the public record in an electronic format or by 18
means of an electronic medium would: 19
(1) Give access to proprietary software; or 20
(2) Require the production of information that is confidential 21
and that cannot be redacted, deleted, concealed or separated from 22
information that is not otherwise confidential. 23
5. An officer, employee or agent of a governmental entity who 24
has legal custody or control of a public record: 25
(a) Shall not refuse to provide a copy of that public record in the 26
medium that is requested because the officer, employee or agent has 27
already prepared o r would prefer to provide the copy in a different 28
medium. 29
(b) Except as otherwise provided in NRS 239.030, shall, upon 30
request, prepare the copy of the public record and shall not require 31
the person who has requested the copy to prepare the copy himself 32
or herself. 33
Sec. 36. NRS 287.010 is hereby amended to read as follows: 34
287.010 1. The governing body of any county, school 35
district, municipal corporation, political subdivision, public 36
corporation or other local governme ntal agency of the State of 37
Nevada may: 38
(a) Adopt and carry into effect a system of group life, accident 39
or health insurance, or any combination thereof, for the benefit of its 40
officers and employees, and the dependents of officers and 41
employees who elect to accept the insurance and who, where 42
necessary, have authorized the governing body to make deductions 43
from their compensation for the payment of premiums on the 44
insurance. 45

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- *SB209*
(b) Purchase group policies of life, accident or health insurance, 1
or any combin ation thereof, for the benefit of such officers and 2
employees, and the dependents of such officers and employees, as 3
have authorized the purchase, from insurance companies authorized 4
to transact the business of such insurance in the State of Nevada, 5
and, where necessary, deduct from the compensation of officers and 6
employees the premiums upon insurance and pay the deductions 7
upon the premiums. 8
(c) Provide group life, accident or health coverage through a 9
self-insurance reserve fund and, where necessary, de duct 10
contributions to the maintenance of the fund from the compensation 11
of officers and employees and pay the deductions into the fund. The 12
money accumulated for this purpose through deductions from the 13
compensation of officers and employees and contributi ons of the 14
governing body must be maintained as an internal service fund as 15
defined by NRS 354.543. The money must be deposited in a state or 16
national bank or credit union authorized to transact business in the 17
State of Nevada. Any independent administrato r of a fund created 18
under this section is subject to the licensing requirements of chapter 19
683A of NRS, and must be a resident of this State. Any contract 20
with an independent administrator must be approved by the 21
Commissioner of Insurance as to the reasona bleness of 22
administrative charges in relation to contributions collected and 23
benefits provided. The provisions of NRS 439.581 to 439.597, 24
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 25
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs 26
(b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 27
and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 28
689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 29
and 689B.500 and section 24 of this act apply to coverage provided 30
pursuant to this paragraph, except that the provisions of NRS 31
689B.0378, 689B.03785 and 689B.500 only apply to coverage for 32
active officers and employees of the governing body, or the 33
dependents of such officers and employees. 34
(d) Defray part or all of the cost of maintenance of a self -35
insurance fund or of the premiums upon insurance. The money for 36
contributions must be budgeted for in accordance with the laws 37
governing the county, school district, municipal corporation, 38
political subdivision, public corporation or other local governmental 39
agency of the State of Nevada. 40
2. If a school district offers group insurance to its officers and 41
employees pursuant to this section, members of the board of trustees 42
of the school district must not be excluded from participating in the 43
group insurance. If the amount of the deductions from compensation 44

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required to pay for the group insurance exceeds the compensation to 1
which a trustee is entitled, the difference must be paid by the trustee. 2
3. In any county in which a legal services organization exists, 3
the governing body of the county, or of any school district, 4
municipal corporation, political subdivision, public corporation or 5
other local governmental agency of the State of Nevada in the 6
county, may enter into a contract with the legal services 7
organization pursuant to which the officers and employees of the 8
legal services organization, and the dependents of those officers a nd 9
employees, are eligible for any life, accident or health insurance 10
provided pursuant to this section to the officers and employees, and 11
the dependents of the officers and employees, of the county, school 12
district, municipal corporation, political subdiv ision, public 13
corporation or other local governmental agency. 14
4. If a contract is entered into pursuant to subsection 3, the 15
officers and employees of the legal services organization: 16
(a) Shall be deemed, solely for the purposes of this section, to be 17
officers and employees of the county, school district, municipal 18
corporation, political subdivision, public corporation or other local 19
governmental agency with which the legal services organization has 20
contracted; and 21
(b) Must be required by the contract t o pay the premiums or 22
contributions for all insurance which they elect to accept or of which 23
they authorize the purchase. 24
5. A contract that is entered into pursuant to subsection 3: 25
(a) Must be submitted to the Commissioner of Insurance for 26
approval not less than 30 days before the date on which the contract 27
is to become effective. 28
(b) Does not become effective unless approved by the 29
Commissioner. 30
(c) Shall be deemed to be approved if not disapproved by the 31
Commissioner within 30 days after its submission. 32
6. As used in this section, “legal services organization” means 33
an organization that operates a program for legal aid and receives 34
money pursuant to NRS 19.031. 35
Sec. 37. NRS 287.04335 is hereby amended to read as 36
follows: 37
287.04335 If the Board provides health insurance through a 38
plan of self -insurance, it shall comply with the provisions of NRS 39
439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 40
687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.25 5, 41
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 42
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 43
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 44
695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, 45

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inclusive, 695G.241 to 695G. 310, inclusive, 695G.405 and 1
695G.415, and section 33 of this act, in the same manner as an 2
insurer that is licensed pursuant to title 57 of NRS is requir ed to 3
comply with those provisions. 4
Sec. 38. The amendatory provisions of this act do not apply to 5
any contract or other agreement entered into before January 1, 2026, 6
but apply to the renewal of any such contract or other agreement. 7
Sec. 39. The provisions of subsection 1 of NRS 218D.380 do 8
not apply to any provision of this act which adds or revises a 9
requirement to submit a report to the Legislature. 10
Sec. 40. The provisions of NRS 354.599 do not apply to any 11
additional expenses of a local government that are related to the 12
provisions of this act. 13
Sec. 41. 1. This section becomes effective upon passage and 14
approval. 15
2. Sections 1 to 40, inclusive, of this act become effective: 16
(a) Upon passage and approval for the purpose of adopting any 17
regulations and performing any other preparatory administrative 18
tasks that are necessary to carry out the provisions of this act; and 19
(b) On January 1, 2026, for all other purposes. 20

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