Revises provisions relating to insurance. (BDR 57-777)

EXEMPT
(Reprinted with amendments adopted on June 2, 2025)
FOURTH REPRINT S.B. 316

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SENATE BILL NO. 316–SENATORS NGUYEN, STONE, TITUS; BUCK,
CRUZ-CRAWFORD, DALY, KRASNER, OHRENSCHALL AND SCHEIBLE

MARCH 11, 2025
____________

JOINT SPONSORS: ASSEMBLYMEMBERS JAUREGUI AND KASAMA
____________

Referred to Committee on Commerce and Labor

SUMMARY—Revises provisions relating to insurance.
(BDR 57-777)

FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
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 insurance; requiring health insurers, pharmacy
benefit managers and the Commissioner of Insurance to
prepare certain reports; expanding the sc ope of certain
provisions relating to pharmacy benefit managers;
prohibiting pharmacy benefit managers from engaging in
certain practices; requiring pharmacy benefit managers to
make certain disclosures; imposing requirements relating
to the compensation o f pharmacy benefit managers;
revising requirements relating to the collection of certain
medical debt; providing civil and criminal penalties; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires a pharmacy benefit manager, which is an entity that 1
manages a pharmacy benefits plan, to obtain a certificate of registration as an 2
insurance administrator from the Commissioner of Insurance and comply with the 3
requirements that apply to insurance administrators generally. (NRS 683A.025, 4
683A.08522-683A.0893) Existing law additionally imposes certain requirements 5
specifically regulating the operation of pharmacy benefit managers. (NRS 6
683A.171-683A.179) Existing law defines “pharmacy b enefits plan” to refer to 7
insurance coverage of prescription drugs. (NRS 683A.175) Section 21 of this bill 8
expands the scope of that definition to also refer to insurance coverage of 9
pharmacist services. Section 21 thereby expands the scope of provisions g overning 10
pharmacy benefit managers to also apply to entities that manage such coverage. 11
Sections 3-14 of this bill define certain other terms relevant to pharmacy benefit 12

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managers, and section 20 of this bill establishes the applicability of those 13
definitions. Section 15 of this bill prohibits a pharmacy benefit manager that 14
manages a pharmacy benefits plan which provides coverage through a network 15
from requiring a person to use a pharmacy affiliated with the pharmacy benefit 16
manager if there are other, non affiliated pharmacies in the network. Section 15 17
additionally prohibits a pharmacy benefit manager from engaging in certain 18
practices which are intended to steer or have the effect of steering a person towards 19
an affiliated pharmacy instead of a nonaffilia ted pharmacy in the network. Section 20
15 also prohibits a pharmacy benefit manager from discriminating against a 21
nonaffiliated pharmacy. 22
Section 16 of this bill requires a pharmacy benefit manager to disclose to a 23
third party insurer for which the pharmac y benefit manager manages a pharmacy 24
benefits plan: (1) the amounts and types of fees that the pharmacy benefit manager 25
charges the third party insurer for managing the plan or otherwise receives from 26
other entities, including rebates, in connection with m anaging the plan; and (2) 27
certain information relating to the clinical efficacy and evidence regarding the 28
inclusion or exclusion of certain drugs in a formulary. Section 16 additionally 29
requires a pharmacy benefit manager to make certain contracts availab le for 30
inspection by the Commissioner. 31
Sections 25, 27-32, 35 and 36 of this bill require certain third party insurers to 32
calculate any cost-sharing obligation for a prescription drug assessed against an 33
insured for the prescription drug: (1) based on the net price that the third party 34
insurer or a pharmacy benefit manager with which the insurer has contracted pays 35
for the drug ; and (2) at the point -of-sale. Section 26 of this bill auth orizes the 36
Commissioner to require a domestic insurer that issues a policy of individual health 37
insurance to a person residing in another state to meet the requirements of section 38
25 in certain circumstances. Sections 33 and 37 of this bill indicate that t he 39
requirements of sections 32 and 36, respectively, are inapplicable to : (1) coverage 40
provided by a managed care organization to recipients of Medicaid because existing 41
law imposes similar requirements of the Medicaid program ; and (2) coverage 42
provided by a managed care organization to members of the Public Employees’ 43
Benefits Program. (NRS 422.4053) Section 41 of this bill makes the requirements 44
of section 36 inapplicable to coverage provided by the Public Employees’ Benefits 45
Program to its members. Section 34 of this bill authorizes the Commissioner to 46
suspend or revoke the certificate of a health maintenance organization that fails to 47
comply with the requirements of section 32. The Commissioner would also be 48
authorized to take such action against other t hird party insurers who fail to comply 49
with the requirements of sections 25, 27-32, 35 and 36. (NRS 680A.200) 50
Section 17 of this bill prohibits a pharmacy benefit manager from: (1) 51
unreasonably obstructing or interfering with the ability of a covered pers on to 52
timely access a prescription drug at certain pharmacies; (2) agreeing to exclusively 53
cover certain drugs; (3) restricting the ability of a nonaffiliated pharmacy to 54
contract with certain entities; and (4) making or disseminating a false or misleading 55
statement or advertisement. Section 24 of this bill additionally prohibits a 56
pharmacy benefit manager from engaging in certain practices while doing business 57
with pharmacies. 58
Section 19 of this bill requires a pharmacy benefit manager to submit to the 59
Commissioner an annual report detailing certain business practices of the pharmacy 60
benefit manager as well as certain information regarding pricing and rebates 61
relating to the prescription drugs administered by the pharmacy benefit manager. 62
Section 1 of this bill requires third party insurers that provide coverage for 63
prescription drugs to submit a similar report to the Commissioner relating to the 64
pricing of prescription drugs. Section 39 of this bill provides for the confidentiality 65
of the information contained in those reports. Sections 1 and 19 require the 66
Commissioner to compile, submit to the Legislature and publish on the Internet 67

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biennial reports on the impact of the cost of prescription drugs on health insurance 68
premiums in this State and the overall impact of pharmacy benefit managers on the 69
cost of prescription drugs in this State, based on the reports submitted by third party 70
insurers and pharmacy benefit managers, respectively. Additionally, section 18 of 71
this bill requires the Commissioner to publish on the Internet certain consumer 72
complaints made against pharmacy benefit managers. 73
Existing law exempts certain federally regulated insurance coverage of 74
prescription drugs provided by employer s for their employees from requirements 75
governing pharmacy benefit managers except where the pharmacy benefit manager 76
is required by contract to comply with those requirements. (NRS 683A.177) 77
Section 22 of this bill provides that such federally regulated c overage provided by 78
employers for their employees is also exempt from the requirements of this bill 79
governing pharmacy benefit managers, unless required by contract to comply with 80
those requirements. Additionally, sections 21.5 and 22 of this bill exempt coverage 81
of prescription drugs provided by the Public Employees’ Benefits Program , 82
insurance plans for local government employees and Medicaid managed care 83
organizations from the requirements of this bill governing pharmacy benefit 84
managers. 85
Existing law p rovides that a pharmacy benefit manager has an obligation of 86
good faith and fair dealing toward a third party insurer or pharmacy when 87
performing duties pursuant to a contract to which the pharmacy benefit manager is 88
a party. (NRS 683A.178) Section 23 of this bill provides that a pharmacy benefit 89
manager also has a fiduciary duty to persons covered by a third party insurer for 90
which the pharmacy benefit manager provides pharmacy benefit services . Section 91
23 also: (1) prohibits a pharmacy benefit manager fro m engaging in an activity that 92
may interfere with the duties and obligations of the pharmacy benefit manager 93
towards third party insurers, pharmacies and covered persons; and (2) authorizes a 94
third party insurer to audit the books and records of a pharmacy benefit manager for 95
certain purposes. 96
Section 18 provides that a pharmacy benefit manager that violates provisions of 97
law governing pharmacy benefit managers, including sections 3-24, is subject to a 98
civil penalty of not less than $1,000 but not more than $7,500 for each violation. 99
Additionally, any violation of sections 3 -24 would be a misdemeanor. 100
(NRS 683A.490) 101
If enacted, sections 13-15 of Assembly Bill No. 343 (A.B. 343) of this session 102
will require a hospital to publish certain information about its prices. Section 17 of 103
A.B. 343 prohibits a hospital from taking certain action to collect medical debt 104
while the hospital is not in compli ance with those requirements or certain similar 105
federal requirements. (45 C.F.R. §§ 180.40, 180.50, 180.60) Section 41.5 of this 106
bill narrows the applicability of that prohibition to only apply to certain medical 107
debt to which the failure to publish accurate pricing information is directly relevant. 108
Section 41.7 of this bill makes a conforming change to A.B. 343 to reflect the 109
revisions made by section 41.5. 110

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

Section 1. Chapter 679B of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. On or before June 1 of each year, a health insurer that 3
provides coverage for prescription drugs shall compile and submit 4

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to the Commissioner a report which contains the following 1
information: 2
(a) Lists of: 3
(1) The 25 prescription drugs most frequently prescribed to 4
insureds in this State during the immediately preceding calendar 5
year; 6
(2) The 25 prescription drugs which accounted for the 7
largest percentage of spending on prescription drugs in this State 8
by the health insurer in the immediately preceding year; and 9
(3) The 25 prescription drugs with the largest increase in 10
the percentage of spending on prescription drugs in this State by 11
the health insurer in the immediately preceding year, as compared 12
to the previous year; and 13
(b) For each prescription drug included on a list compiled 14
pursuant to paragraph (a) for the immediately preceding year: 15
(1) The aggregate wholesale acquisition cos ts for the drug, 16
calculated by adding together for all units of the drug dispensed to 17
insureds in this State the wholesale acquisition cost of the drug at 18
the time each unit was dispensed; 19
(2) The aggregate amount of rebates received by a 20
pharmacy benefi t manager under contract with the insurer 21
relating to the distribution of the drug to insureds in this State; 22
(3) The aggregate amount of administrative fees received 23
by a pharmacy benefit manager under contract with the insurer 24
relating to the distribution of the drug to insureds in this State; 25
(4) The aggregate amount paid or reimbursed by a 26
pharmacy benefit manager under contract with the insurer to 27
affiliated pharmacies in this State for the drug; 28
(5) The aggregate amount paid or reimbursed by a 29
pharmacy benefit manager under contract with an insurer to 30
nonaffiliated pharmacies in this State for the drug; and 31
(6) The aggregate amount of fees received from any source 32
by a pharmacy benefit manager under contract with the insurer 33
relating to the distribution of the drug to insureds in this State. 34
2. On or before July 1 of each even -numbered year, the 35
Commissioner shall: 36
(a) Compile a report on the overall impact of prescription drug 37
costs on premiums for health insurance in this State based on the 38
reports submitted to the Commissioner pursuant to subsection 1. 39
The data in the report compiled pursuant to this subsection must 40
be in aggregated form and must not reveal information specific to 41
a particular health insurer or manufacturer of a drug, inclu ding, 42
without limitation, information relating to a manufacturer’s 43
individual or aggregate discounted prices for a prescription drug. 44

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(b) Submit the report to the Director of the Legislative Counsel 1
Bureau for transmittal to the Joint Interim Standing Com mittee 2
on Health and Human Services and the Joint Interim Standing 3
Committee on Commerce and Labor. 4
(c) Present the report at a meeting of the Joint Interim 5
Standing Committee on Health and Human Services. 6
(d) Post the report on an Internet website opera ted by the 7
Division. 8
3. Except as otherwise provided in subsection 2, any 9
information submitted by a health insurer pursuant to this section 10
is confidential and is not a public record. 11
4. As used in this section: 12
(a) “Affiliated pharmacy” has the meaning ascribed to it in 13
section 3 of this act. 14
(b) “Health insurer” means any insurer or organization 15
authorized pursuant to this title to conduct business in this State 16
that provides or arranges for the provision of he alth care services, 17
including, without limitation, an insurer that issues a policy of 18
health insurance, an insurer that issues a policy of group health 19
insurance, a carrier serving small employers, a fraternal benefit 20
society, a hospital or medical service s corporation, a health 21
maintenance organization, a plan for dental care, a prepaid 22
limited health service organization and a managed care 23
organization. 24
(c) “Insured” means a person covered by a policy of health 25
insurance issued in this State by a health insurer. 26
(d) “Manufacturer” has the meaning ascribed to it in 42 27
U.S.C. § 1396r-8(k)(5). 28
(e) “National Drug Code” means the numerical code assigned 29
to a prescription drug by the United States Food and Drug 30
Administration. 31
(f) “Nonaffiliated pharmacy” has the meaning ascribed to it in 32
section 9 of this act. 33
(g) “Pharmacy benefit manager” has the meaning ascribed to 34
it in NRS 683A.174. 35
(h) “Rebate” has the meaning ascribed to it in section 13 of 36
this act. 37
(i) “Wholesale acquisition cost” means the manuf acturer’s 38
published list price for a prescription drug with a unique National 39
Drug Code for sale to a purchaser or entity that purchases the 40
prescription drug from the manufacturer, not including any 41
rebates or other price concessions. 42

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Sec. 2. Chapter 683A of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 3 to 19, inclusive, of this 2
act. 3
Sec. 3. “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. 4. “Claim” means a request for payment for: 8
1. Administering, filling or refilling a prescription; or 9
2. Providing a pharmacist service or a medical supply or 10
device to a covered person. 11
Sec. 5. “Control” has the meaning ascribed to it in 12
NRS 692C.050. 13
Sec. 6. “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. 7. “Manufacturer” has the meaning ascribed to it in 42 18
U.S.C. § 1396r-8(k)(5). 19
Sec. 8. “Network plan” means a pharmacy benefits plan 20
offered by a third party under which the financing and delivery of 21
pharmacist services is provide d, 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
Sec. 9. “Nonaffiliated pharmacy” means a pharmacy that: 26
1. Directly, or indirectly through a pharmacy services 27
administrative organization, contracts with a pharmacy benefit 28
manager; and 29
2. Does not control, is not controlled by and is not under 30
common control with the pharmacy benefit manager. 31
Sec. 10. “Pharmacist services” means the provision of 32
products, goods or services, or any combination thereof, provided 33
as a part of the practice of pharmacy, as defined in NRS 639.0124. 34
Sec. 11. “Pharmacy benefit management services” includes, 35
without limitation: 36
1. Negotiating the price of prescription drugs, including, 37
without limitation, negotiating or contracting for direct or indirect 38
rebates, discounts or price concessions on prescription drugs. 39
2. Managing any aspect of a pharmacy benefits plan, 40
including, without limitation: 41
(a) Developing or managing a formulary; 42
(b) Processing and paying claims for prescription drugs; 43
(c) Performing reviews of the utilization of prescription drugs; 44

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(d) Processing requests for prior authorization for 1
prescriptions; 2
(e) Adjudicating appeals and grievances relating to a 3
pharmacy benefits plan; 4
(f) Contracting with pharmacies to provide pharmacist services 5
for covered persons; 6
(g) Managing the cost of covered prescription drugs on behalf 7
of a third party; and 8
(h) Managing or providing data relating to a pharmacy 9
benefits plan. 10
3. Performing any administrative, managerial, clinical, 11
pricing, financial, reimbursement, data administration, reporting 12
or billing service for a third party in relation to a pharmacy 13
benefits plan. 14
Sec. 12. “Pharmacy services administrative organization” 15
means an entity that provides contracting and other administrative 16
services relating to prescription drug benefits to pharmacies. 17
Sec. 13. “Rebate” means any discount, remuneration or 18
other payment paid by a manufacturer or wholesaler to a 19
pharmacy benefit manager after a claim has been adjudicated or 20
completed at a pharmacy. The term does not include a bona fide 21
service fee, as defined in 42 C.F.R. § 447.502. 22
Sec. 14. “Wholesaler” has the meaning ascribed to it in 23
NRS 639.016. 24
Sec. 15. 1. A ph armacy benefit manager that manages a 25
network plan shall not: 26
(a) Require a covered person to use an affiliated pharmacy to 27
fill a prescription or obtain other pharmacist services if there is a 28
nonaffiliated pharmacy in the applicable network; 29
(b) Induce, persuade or attempt to induce or persuade a 30
covered person to transfer a prescription to or otherwise use an 31
affiliated pharmacy instead of a nonaffiliated pharmacy in the 32
applicable network; 33
(c) Unreasonably restrict a covered person from using a 34
particular pharmacy in the applicable network for the purpose of 35
filling a prescription or receiving pharmacist services covered by 36
the pharmacy benefits plan of the covered person; 37
(d) Communicate to a covered person that the covered person 38
is required to have a prescription filled or receive other pharmacist 39
services at a particular pharmacy if there are other pharmacies in 40
the applicable network that have the ability to dispense the 41
prescription or provide the pharmacist services required by the 42
covered person; 43

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(e) Discriminate against a nonaffiliated pharmacy based on 1
the nonaffiliated status of the pharmacy, including, without 2
limitation, by: 3
(1) Offering materially different terms or conditions to a 4
nonaffiliated pharmacy based on the status as a nonaff iliated 5
pharmacy; 6
(2) Refusing to renew or terminating a contract with a 7
nonaffiliated pharmacy on the basis that the pharmacy is a 8
nonaffiliated pharmacy, or for reasons other than those that apply 9
equally to affiliated pharmacies; and 10
(3) Reimbursing a nonaffiliated pharmacy for a pharmacist 11
service in an amount that is less than the pharmacy benefit 12
manager would reimburse an affiliated pharmacy for the same 13
pharmacist service; or 14
(f) Deny a pharmacy the opportunity to participate in a 15
network or receive a preferred status if the pharmacy is willing to 16
accept the same terms and conditions that the pharmacy benefit 17
manager has established for affiliated pharmacies as a condition 18
for participating in the network or receiving preferred status, as 19
applicable. 20
2. As used in this section, “network” means a defined set of 21
pharmacies that are under contract to provide pharmacist services 22
pursuant to a network plan. 23
Sec. 16. A pharmacy benefit manager: 24
1. Upon the request of a third party for which the pharmacy 25
benefit manager manages a pharmacy benefits plan, shall disclose 26
to the third party, in writing, the amounts and types of charges, 27
fees and commissions in the aggregate that the pharmacy benefit 28
manager charges the third party for providing pharmacy benefit 29
management services or otherwise receives in connection with 30
managing the pharmacy benefits plan of the third party, 31
including, without limitation, administrative fees and rebates 32
collected from pharmacies, manufacturers and wholesalers. 33
2. Shall make available for inspection by the Commissioner, 34
upon request of the Commissioner, any contract between the 35
pharmacy benefit manager and a pharmacy or a third party. 36
3. Shall disclose to a third p arty for which the pharmacy 37
benefit manager manages a pharmacy benefits plan, upon request 38
of the third party, information relating to the clinical efficacy and 39
clinical evidence regarding the inclusion, exclusion or limitation 40
of prescription drugs in a f ormulary maintained by the pharmacy 41
benefit manager. 42
Sec. 16.5. (Deleted by amendment.) 43
Sec. 17. 1. A pharmacy benefit manager shall not: 44

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(a) Unreasonably obstruct or interfere with the ability of a 1
covered person to timely access a prescription drug or device that 2
has been prescribed to the covered person at a contract pharmacy 3
of the person’s choice. 4
(b) Enter into, amend, enforce or renew a contract with a 5
manufacturer that expressly or implicitly provides for the 6
exclusive coverage of a drug, medical device or other product by a 7
pharmacy benefits plan or group of pharmacy benefits plans. 8
(c) Enter into, amend, enforce or renew a contract with a 9
pharmacy or pharmacy services administr ative organization that 10
expressly or implicitly restricts the ability of a nonaffiliated 11
pharmacy to contract with third parties. 12
(d) Make or disseminate any statement, representation or 13
advertisement that is, or reasonably should be known to be, 14
untrue, deceptive or misleading. 15
2. As used in this section, “contract pharmacy” means a 16
pharmacy that contracts directly with a pharmacy benefit 17
manager, or indirectly with a pharmacy benefit manager through 18
a pharmacy services administrative organization. 19
Sec. 18. 1. A pharmacy benefit manager that violates the 20
provisions of NRS 683A.171 to 683A.179, inclusive, and sections 3 21
to 19, inclusive, of this act is subject to a civil penalty of not less 22
than $1,000, but not more than $7,500, for each violation. This 23
penalty must be recovered in a civil action brought in the name of 24
the State of Nevada by the Attorney General. 25
2. The remedies and penalties set forth in this section are not 26
exclusive and are in addition to any other re medies and penalties 27
provided by law. 28
3. The Commissioner shall: 29
(a) Establish procedures for receiving, investigating, tracking 30
and publicly reporting complaints submitted by persons in this 31
State against pharmacy benefit managers. 32
(b) Publish on an I nternet website maintained by the 33
Commissioner each complaint against a pharmacy benefit 34
manager received pursuant to paragraph (a) which is determined 35
by the Commissioner to be justified based on a determination by a 36
preponderance of the evidence that the pharmacy benefit manager 37
violated the provisions of NRS 683A.171 to 683A.179, inclusive, 38
and sections 3 to 19, inclusive, of this act. 39
Sec. 19. 1. On or before April 1 of each year, a pharmacy 40
benefit manager shall submit to the Commissioner: 41
(a) A report which includes the information prescribed by 42
subsection 2; and 43
(b) A statement signed under the penalty of perjury affirming 44
the accuracy of the information in the report. 45

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

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(2) Amount of rebates negotiated for the purchase of the 1
drug in this State; 2
(3) Amount of administrative fees received from a 3
manufacturer or wholesaler for services provided in this State 4
relating to the drug; 5
(4) Amount paid or reimbursed to affiliated pharmacies in 6
this State for the drug; and 7
(5) Amount paid or reimbursed to nonaffiliated pharmacies 8
in this State for the drug. 9
(e) A list of the third parties with which the pharmacy benefit 10
manager has contracted, the scope of services provided to each 11
third party and the number of persons covered in this State by 12
each third party listed. 13
(f) The total amount of revenue derived from providing 14
pharmacy benefit management services in this State in the 15
immediately preceding year. 16
(g) The expenses incurred by providing pharmacy ben efit 17
management services in this State in the immediately preceding 18
year. 19
(h) The identity of each group purchasing organization 20
employed, contracted or otherwise utilized by or affiliated with the 21
pharmacy benefit manager. 22
(i) A copy of each contract en tered into with a group 23
purchasing organization identified pursuant to paragraph (h). 24
(j) The aggregate financial benefit derived in the immediately 25
preceding year from the use of the group purchasing 26
organizations identified pursuant to paragraph (h). 27
(k) A list of the types and amounts of fees that the pharmacy 28
benefit manager has collected during the immediately preceding 29
year for performing pharmacy benefit management services in this 30
State and a description of how those fees are calculated. 31
(l) A copy of all fee agreements entered into with third parties, 32
pharmacies and pharmacy services administrative organizations 33
doing business in this State. 34
(m) The amount of each premium, deductible, cost -sharing 35
obligation or fee charged by the pharmacy benefi t manager to 36
covered persons in this State or other persons on behalf of such 37
covered persons. 38
3. On or before July 1 of each even -numbered year, the 39
Commissioner shall: 40
(a) Compile a report on the overall impact of pharmacy benefit 41
managers on the cost of prescription drugs in this State based on 42
the reports submitted to the Commissioner pursuant to subsection 43
1. The data in the report compiled pursuant to this subsection 44
must be in aggregated form and must not reveal information 45

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specifically concerning an individual purchaser or manufacturer 1
of a drug, including, without limitation, information relating to a 2
manufacturer’s individual or aggregate discounted prices for a 3
prescription drug. 4
(b) Submit the report to the Director of the Legislative Counsel 5
Bureau for transmittal to the Joint Interim Standing Committee 6
on Health and Human Services and the Joint Interim Standing 7
Committee on Commerce and Labor. 8
(c) Present the report at a meeting of the Joint Interim 9
Standing Committee on Health and Human Services. 10
(d) Post the report on an Internet website operated by the 11
Division. 12
4. Except as otherwise provided in subsection 3, any 13
information submitted by a pharmacy benefit manager pursuant to 14
this section is confidential and is not a public record. 15
5. Nothing in this section shall be construed to impose any 16
recordkeeping obligation on a third party for which a pharmacy 17
benefit manager manages a pharmacy benefits plan. 18
6. As used in this section: 19
(a) “Group purchasing organization” means a person 20
employed, contracted or otherwise utilized by or affiliated with a 21
pharmacy benefit manager to negotiate, obtain or procure rebates 22
from manufacturers or wholesalers. 23
(b) “National Drug Code” means the numerical code assigned 24
to a prescription drug by the United States Food and Drug 25
Administration. 26
(c) “Wholesale acquisition cost” means the manufacturer’s 27
published list price for a prescription drug with a unique National 28
Drug Code for sale to a wholesaler or any other purchaser or 29
entity that purchases the prescription drug from the manufacturer, 30
not including any rebates or other price concessions. 31
Sec. 20. NRS 683A.171 is hereby amended to read as follows: 32
683A.171 As used in NRS 683A.171 to 683A.179, inclusive, 33
and sec tions 3 to 19, inclusive, of this act, unless the context 34
otherwise requires, the words and terms defined in NRS 683A.172 35
to 683A.176, inclusive, and sections 3 to 14, inclusive, of this act 36
have the meanings ascribed to them in those sections. 37
Sec. 21. NRS 683A.175 is hereby amended to read as follows: 38
683A.175 “Pharmacy benefits plan” means coverage of 39
prescription drugs and pharmacist services provided by a third 40
party. 41
Sec. 21.5. NRS 683A.176 is hereby amended to read as 42
follows: 43
683A.176 “Third party” means: 44
1. An insurer, as that term is defined in NRS 679B.540; 45

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2. A health benefit plan, as that term is defined in NRS 1
687B.470, for employees which provides a pharmacy benefits plan; 2
3. [A participating public agency, as that term is defined in 3
NRS 287.04052, and any other local governmental agency of the 4
State of Nevada which provides a system of health insurance for the 5
benefit of its officers and employees, and the dependents of officers 6
and employees, pursuant to chapter 287 of NRS; 7
4.] The Public Option established pursuant to NRS 695K.200; 8
or 9
[5.] 4. Any other insurer or organization that provides health 10
coverage or benefits or coverage of prescription drugs a s part of 11
workers’ compensation insurance in accordance with state or federal 12
law. 13
 The term does not include the Public Employees’ Benefits 14
Program, a local government al agency o f the State of Nevada 15
which provides a system of health insurance for the benefit of its 16
officers and employees, and the dependents of officers and 17
employees, pursuant to chapter 287 of NRS or an insurer that 18
provides coverage under a policy of casualty or property insurance. 19
Sec. 22. NRS 683A.177 is hereby amended to read as follows: 20
683A.177 1. Except as otherwise provided in subsection 2, 21
the requirements of NRS 683A.171 to 683A.179, inclusive, and 22
sections 3 to 19, inclusive, of this act and any regulations adopted 23
by the Commissioner pursuant thereto do not apply to the coverage 24
of prescription drugs under a plan that is subject to the Employee 25
Retirement Income Security Act of 1974 or any information relating 26
to such coverage. 27
2. A plan described in subsection 1 may, by contract, require a 28
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 3 to 19, 31
inclusive, of this act and any regulations adopted by the 32
Commissioner pursuant thereto. 33
3. The requirements of NRS 683A.171 to 683A.179, inclusive, 34
and sections 3 to 19, inclusive, of this act do not apply to the 35
coverage of prescription drugs provided by a managed care 36
organization for: 37
(a) Recipients of Medicaid under the State Plan for Medicaid 38
or the Children’s Health Insurance Program pursuant to a 39
contract with the Division of Health Care Financing and Policy of 40
the Department of Health and H uman Services entered into 41
pursuant to NRS 422.273; 42
(b) Members of the Public Employees’ Benefits Program; or 43
(c) The officers and employees, and the dependents of officers 44
and employees, of the governing body of any county, school 45

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- *SB316_R4*
district, municipal corporation, political subdivision, public 1
corporation or other local governmental agency of this State. 2
Sec. 23. NRS 683A.178 is hereby amended to read as follows: 3
683A.178 1. A pharmacy benefit manager has [an] : 4
(a) A fiduciary duty to persons covered by a third party with 5
which the pharmacy benefit manager has entered into an 6
agreement to provide pharmacy benefit management services; and 7
(b) Except as otherwise provided in subsection 2, an obligation 8
of good faith and fair dealing toward a third party or pharmacy 9
when performing duties pursuant to a contract to which the 10
pharmacy benefit manager is a party. [Any provision of a contract 11
that waives or limits that obligation is against public policy, void 12
and unenforceable.] 13
2. If the duties established in paragraphs (a) and (b) of 14
subsection 1 conflict, the duty established in paragraph (a) of 15
subsection 1 supersedes the duty established in paragraph (b) 16
of subsection 1. 17
3. A pharmacy benefit manager [shall] : 18
(a) Shall notify a third party or pharmacy with which it has 19
entered into a contract in writing of any activity, policy or practice 20
of the pharmacy benefit manager that presents a conflict of interest 21
that interferes with the duties or obligations imposed by 22
subsection 1. 23
(b) Shall not engage in any activity or implement any policy or 24
practice that the pharmacy benefit manager reasonably anticipates 25
will present a conflict of interest that interferes with the ability of 26
the pharmacy benefit manager to discharge any duty or obligation 27
imposed by subsection 1. 28
[3.] 4. A third party with which a pharmacy benefit manager 29
has entered into a n agreement may audit all books and records of 30
the pharmacy benefit manager to the extent necessary to fulfill all 31
contractual obligations to covered persons and ensure compliance 32
with the provisions of the agreement, this chapter and the 33
regulations adopted pursuant thereto. Such an audit may include, 34
without limitation, an examination of claims for pharmacy 35
benefits, rebates and any other information necessary to 36
accomplish the purposes set forth in this subsection. 37
5. A pharmacy benefit manager that manages prescription drug 38
benefits for an insurer licensed pursuant to this title shall comply 39
with the provisions of this title which are applicable to the insurer 40
when managing such benefits for the insurer. 41
6. Any provision of a contract that waives or l imits any duty 42
or obligation imposed by this section is against public policy, void 43
and unenforceable. 44

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- *SB316_R4*
Sec. 24. NRS 683A.179 is hereby amended to read as follows: 1
683A.179 1. A pharmacy benefit manager shall not: 2
(a) Prohibit a pharmacist or pharmacy from providing 3
information to a covered person concerning: 4
(1) The amount of any copayment or coinsurance for a 5
prescription drug; or 6
(2) The availability of a less expensive alternative or generic 7
drug including, with out limitation, information concerning clinical 8
efficacy of such a drug; 9
(b) Penalize a pharmacist or pharmacy for providing the 10
information described in paragraph (a) or selling a less expensive 11
alternative or generic drug to a covered person; 12
(c) Prohibit a pharmacy from offering or providing delivery 13
services directly to a covered person as an ancillary service of the 14
pharmacy; [or] 15
(d) If the pharmacy benefit manager manages a pharmacy 16
benefits plan that provides coverage through a network plan, cha rge 17
a copayment or coinsurance for a prescription drug in an amount 18
that is greater than the total amount paid to a pharmacy that is in the 19
network of providers under contract with the third party [.] ; 20
(e) Restrict, by contract or otherwise, the ability of a pharmacy 21
to share or disclose the details of a contract between the pharmacy 22
and the pharmacy benefit manager with the Commissioner; 23
(f) Reimburse a pharmacy for a prescription drug in an 24
amount that is less than the pharmacy pays a wholesaler for th e 25
prescription drug, as reflected on the invoice provided by the 26
wholesaler to the pharmacy; 27
(g) Directly or indirectly reduce or allow the reduction of any 28
payment to a pharmacy under a pharmacy benefits plan managed 29
by the pharmacy benefit manager under a reconciliation process 30
to an effective rate of reimbursement; 31
(h) Directly or indirectly retroactively reduce or deny a claim 32
after the claim has been adjudicated unless: 33
(1) The original claim is fraudulent; 34
(2) The original payment of the claim w as incorrect 35
because the pharmacy or pharmacist had already been paid for the 36
pharmacist services to which the claim relates; or 37
(3) The pharmacy or pharmacist that submitted the claim 38
did not render the pharmacist services to which the claim relates; 39
(i) Reverse and resubmit the claim of a pharmacy: 40
(1) Without notifying and attempting to reconcile the claim 41
with the pharmacy; or 42
(2) More than 90 days after the claim was first affirmatively 43
adjudicated; 44

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- *SB316_R4*
(j) Charge a pharmacy or a pharmacist a fee to process a claim 1
electronically; 2
(k) Refuse to pay a claim after terminating a contract with a 3
pharmacy, except where the pharmacy benefit manager is 4
investigating possible insurance fraud; or 5
(l) Retaliate against a pharmacy for reporting a potential o r 6
actual violation of this title or attempting to settle a dispute with a 7
pharmacy benefit manager based on a potential or actual violation 8
of this title. 9
2. The provisions of this section: 10
(a) Must not be construed to authorize a pharmacist to dispense 11
a drug that has not been prescribed by a practitioner, as defined in 12
NRS 639.0125, except to the extent authorized by a specific 13
provision of law, including, without limitation, NRS 453C.120, 14
639.28078 and 639.28085. 15
(b) Do not apply to an institutional pharmacy, as defined in NRS 16
639.0085, or a pharmacist working in such a pharmacy as an 17
employee or independent contractor. 18
3. Any provision of a contract that restricts the ability of a 19
pharmacy to share information pursuant to paragraph (e) of 20
subsection 1 is against public policy, void and unenforceable. 21
4. As used in this section, [“network plan” means a health 22
benefit plan offered by a health carrier under which the financing 23
and delivery of medical care is provided, in whole or in part, 24
through a d efined set of providers under contract with the carrier. 25
The term does not include an arrangement for the financing of 26
premiums.] “retaliate” includes, without limitation: 27
(a) Terminating or refusing to renew a contract with a 28
pharmacy. 29
(b) Making the re newal of a contract with a pharmacy 30
contingent on the pharmacy acceding to terms and conditions not 31
applicable to other pharmacies. 32
(c) Subjecting the pharmacy to increased audits. 33
(d) Failing to promptly pay or reimburse a pharmacy without 34
substantial justification. 35
Sec. 25. Chapter 689A of NRS is hereby amended by adding 36
thereto a new section to read as follows: 37
1. An insurer that offers or issues a policy of health 38
insurance which provides coverage for prescription d rugs shall 39
calculate any cost-sharing obligation imposed against an insured 40
for a prescription drug based on the net price paid for the drug . 41
Any such cost -sharing obligation must be calculated at the 42
point-of-sale. 43
2. As used in this section: 44

– 17 –

- *SB316_R4*
(a) “Cost-sharing obligation” has the meaning ascribed to it in 1
section 6 of this act. 2
(b) “Net price paid” means the price paid for a prescription 3
drug by an insurer or a pharmacy benefit manager with which an 4
insurer has contracted, inclusive of any rebates received for the 5
prescription drug. 6
(c) “Pharmacy benefit manager” has the meaning ascribed to 7
it in NRS 683A.174. 8
(d) “Rebate” has the meaning ascribed to it in section 13 of 9
this act. 10
Sec. 26. NRS 689A.330 is hereby amended to read as follows: 11
689A.330 If any policy is issued by a domestic insurer for 12
delivery to a person residing in another state, and if the insurance 13
commissioner or corresponding public officer of that other state has 14
informed the Commissioner that the policy is not subject to approval 15
or disapproval by that officer, the Commissioner may by ruling 16
require that the policy meet the standards set forth in NRS 689A.030 17
to 689A.320, inclusive [.] , and section 25 of this act. 18
Sec. 27. Chapter 689B of NRS is hereby amended by adding 19
thereto a new section to read as follows: 20
1. An insurer that offers or issues a policy of group health 21
insurance which provides coverage for prescription drugs shall 22
calculate any cost-sharing obligation imposed against an insured 23
for a prescription drug based on the net price paid for the drug . 24
Any such cost -sharing obligation must be calculated at the 25
point-of-sale. 26
2. As used in this section: 27
(a) “Cost-sharing obligation” has the meaning ascribed to it in 28
section 6 of this act. 29
(b) “Net price paid” means the price paid for a prescription 30
drug by an insurer or a pharmacy benefit manager with which an 31
insurer has contracted, inclusive of any rebates received for the 32
prescription drug. 33
(c) “Pharmacy benefit manager” has the meaning ascribed to 34
it in NRS 683A.174. 35
(d) “Rebate” has the meaning ascribed to it in section 13 of 36
this act. 37
Sec. 28. Chapter 689C of NRS is hereby amended by ad ding 38
thereto a new section to read as follows: 39
1. A carrier that offers or issues a health benefit plan which 40
provides coverage for prescription drugs shall calculate any cost-41
sharing obligation imposed against an insured for a prescription 42
drug based on the net price paid for the drug . Any such cost -43
sharing obligation must be calculated at the point-of-sale. 44
2. As used in this section: 45

– 18 –

- *SB316_R4*
(a) “Cost-sharing obligation” has the meaning ascribed to it in 1
section 6 of this act. 2
(b) “Net price paid” means the price paid for a prescription 3
drug by a carrier or a pharmacy benefit manager with which a 4
carrier has contracted, inclusive of any rebates received for the 5
prescription drug. 6
(c) “Pharmacy benefit manager” has the meaning ascribed to 7
it in NRS 683A.174. 8
(d) “Rebate” has the meaning ascribed to it in section 13 of 9
this act. 10
Sec. 29. NRS 689C.425 is hereby amended to read as follows: 11
689C.425 A voluntary purchasing group and any contract 12
issued to such a group pursuan t to NRS 689C.360 to 689C.600, 13
inclusive, are subject to the provisions of NRS 689C.015 to 14
689C.355, inclusive, and section 28 of this act, to the extent 15
applicable and not in conflict with the express provisions of NRS 16
687B.408 and 689C.360 to 689C.600, inclusive. 17
Sec. 30. Chapter 695A of NRS is hereby amended by adding 18
thereto a new section to read as follows: 19
1. A society that offers or issues a benefit contract which 20
provides coverage for prescription drugs shall calculate any cost-21
sharing obligation imposed against an insured for a prescription 22
drug based on the net price paid for the drug . Any such cost -23
sharing obligation must be calculated at the point-of-sale. 24
2. As used in this section: 25
(a) “Cost-sharing obligation” has the meaning ascribed to it in 26
section 6 of this act. 27
(b) “Net price paid” means the price paid for a prescription 28
drug by a society or a pharmacy benefit manager with which a 29
society has contracted, inclusive of any rebat es received for the 30
prescription drug. 31
(c) “Pharmacy benefit manager” has the meaning ascribed to 32
it in NRS 683A.174. 33
(d) “Rebate” has the meaning ascribed to it in section 13 of 34
this act. 35
Sec. 31. Chapter 695B of NRS is hereby amended by adding 36
thereto a new section to read as follows: 37
1. A hospital or medical services corporation that offers or 38
issues a policy of health insurance which provides coverage for 39
prescription drugs shall calculate any cost-sharing obligation 40
imposed against an insured for a prescription drug based on the 41
net price paid for the drug. Any such cost-sharing obligation must 42
be calculated at the point-of-sale. 43
2. As used in this section: 44

– 19 –

- *SB316_R4*
(a) “Cost-sharing obligation” has the meaning ascribed to it in 1
section 6 of this act. 2
(b) “Net price paid” means the price paid for a prescription 3
drug by a hospital or medical services corporation or a pharmacy 4
benefit manager with which a hospital or medic al services 5
corporation has contracted, inclusive of any rebates received for 6
the prescription drug. 7
(c) “Pharmacy benefit manager” has the meaning ascribed to 8
it in NRS 683A.174. 9
(d) “Rebate” has the meaning ascribed to it in section 13 of 10
this act. 11
Sec. 32. Chapter 695C of NRS is hereby amended by adding 12
thereto a new section to read as follows: 13
1. A health maintenance organization that offers or issues a 14
health care plan which provides coverage for prescription drugs 15
shall calculate any cost-sharing obligation imposed against an 16
enrollee for a prescription drug based on the net price paid for the 17
drug. Any such cost -sharing obligation must be calculated at the 18
point-of-sale. 19
2. As used in this section: 20
(a) “Cost-sharing obligation” has the meaning ascribed to it in 21
section 6 of this act. 22
(b) “Net price paid” means the price paid for a prescription 23
drug by a health maintenance organization or a pharmacy benefit 24
manager with which a health maintenance organiz ation has 25
contracted, inclusive of any rebates received for the prescription 26
drug. 27
(c) “Pharmacy benefit manager” has the meaning ascribed to 28
it in NRS 683A.174. 29
(d) “Rebate” has the meaning ascribed to it in section 13 of 30
this act. 31
Sec. 33. NRS 695C.050 is hereby amended to read as follows: 32
695C.050 1. Except as otherwise provided in this chapter or 33
in specific provisions of this title, the provisions of this title are not 34
applicable to any health maintenance organization granted a 35
certificate of authority under this chapter. This provision does not 36
apply to an insurer licensed and regulated pursuant to this title 37
except with respect to its activities as a health maintenance 38
organization authorized and regulated pursuant to this chapter. 39
2. Solicitation of enrollees by a health maintenance 40
organization granted a certificate of authority, or its representatives, 41
must not be construed to violate any provision of law relating to 42
solicitation or advertising by practitioners of a healing art. 43

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- *SB316_R4*
3. Any health maintenance organization authorized under this 1
chapter shall not be deemed to be practicing medicine and is exempt 2
from the provisions of chapter 630 of NRS. 3
4. The provisions of NRS 695C.110, 695C.125, 695C.1 691, 4
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 5
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 6
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 7
inclusive, and 695C.265 and section 32 of this act do not apply to a 8
health maintenan ce organization that provides health care services 9
through managed care to recipients of Medicaid under the State Plan 10
for Medicaid or insurance pursuant to the Children’s Health 11
Insurance Program pursuant to a contract with the Division of 12
Health Care Fin ancing and Policy of the Department of Health and 13
Human Services. This subsection does not exempt a health 14
maintenance organization from any provision of this chapter for 15
services provided pursuant to any other contract. 16
5. The provisions of NRS 695C.169 32 to 695C.1699, 17
inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 18
695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, 19
inclusive, 695C.1757 and 695C.204 apply to a health maintenance 20
organization that provides health care services through mana ged 21
care to recipients of Medicaid under the State Plan for Medicaid. 22
6. The provisions of NRS 695C.17095 and section 32 of this 23
act do not apply to a health maintenance organization that provides 24
health care services to members of the Public Employees’ Benefits 25
Program. This subsection does not exempt a health maintenance 26
organization from any provision of this chapter for services 27
provided pursuant to any other contract. 28
7. The provisions of NRS 695C.1735 do not apply to a health 29
maintenance organization that provides health care services to: 30
(a) The officers and employees, and the dependents of officers 31
and employees, of the governing body of any county, school district, 32
municipal corporation, political subdivision, public corporation or 33
other local governmental agency of this State; or 34
(b) Members of the Public Employees’ Benefits Program. 35
 This subsection does not exempt a health maintenance 36
organization from any provision of this chapter for services 37
provided pursuant to any other contract. 38
Sec. 34. NRS 695C.330 is hereby amended to read as follows: 39
695C.330 1. The Commissioner may suspend or revoke any 40
certificate of authority issued to a health maintenance organization 41
pursuant to the provisions of this chapter if the Commissioner finds 42
that any of the following conditions exist: 43
(a) The health maintenance organization is operating 44
significantly in contravention of its basic organizational document, 45

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- *SB316_R4*
its health care plan or in a manner contrary to th at described in and 1
reasonably inferred from any other information submitted pursuant 2
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 3
to those submissions have been filed with and approved by the 4
Commissioner; 5
(b) The health maintenance orga nization issues evidence of 6
coverage or uses a schedule of charges for health care services 7
which do not comply with the requirements of NRS 695C.1691 to 8
695C.200, inclusive, and section 32 of this act or 695C.204 or 9
695C.207; 10
(c) The health care plan doe s not furnish comprehensive health 11
care services as provided for in NRS 695C.060; 12
(d) The Commissioner certifies that the health maintenance 13
organization: 14
(1) Does not meet the requirements of subsection 1 of NRS 15
695C.080; or 16
(2) Is unable to fulfill its obligations to furnish health care 17
services as required under its health care plan; 18
(e) The health maintenance organization is no longer financially 19
responsible and may reasonably be expected to be unable to meet its 20
obligations to enrollees or prospective enrollees; 21
(f) The health maintenance organization has failed to put into 22
effect a mechanism affording the enrollees an opportunity to 23
participate in matters relating to the content of programs pursuant to 24
NRS 695C.110; 25
(g) The health maintenance o rganization has failed to put into 26
effect the system required by NRS 695C.260 for: 27
(1) Resolving complaints in a manner reasonably to dispose 28
of valid complaints; and 29
(2) Conducting external reviews of adverse determinations 30
that comply with the provis ions of NRS 695G.241 to 695G.310, 31
inclusive; 32
(h) The health maintenance organization or any person on its 33
behalf has advertised or merchandised its services in an untrue, 34
misrepresentative, misleading, deceptive or unfair manner; 35
(i) The continued operat ion of the health maintenance 36
organization would be hazardous to its enrollees or creditors or to 37
the general public; 38
(j) The health maintenance organization fails to provide the 39
coverage required by NRS 695C.1691; or 40
(k) The health maintenance organizat ion has otherwise failed to 41
comply substantially with the provisions of this chapter. 42
2. A certificate of authority must be suspended or revoked only 43
after compliance with the requirements of NRS 695C.340. 44

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- *SB316_R4*
3. If the certificate of authority of a health maintenance 1
organization is suspended, the health maintenance organization shall 2
not, during the period of that suspension, enroll any additional 3
groups or new individual contracts, unless those groups or persons 4
were contracted for before the date of suspension. 5
4. If the certificate of authority of a health maintenance 6
organization is revoked, the organization shall proceed, immediately 7
following the effective date of the order of revocation, to wind up its 8
affairs and shall conduct no further business except as may be 9
essential to the orderly conclusion of the affairs of the organization. 10
It shall engage in no further advertising or solicitation of any kind. 11
The Commissioner may, by written order, permit such further 12
operation of the organization as the Commissioner may find to be in 13
the best interest of enrollees to the end that enrollees are afforded 14
the greatest practical opportunity to obtain continuing coverage for 15
health care. 16
Sec. 35. Chapter 695F of NRS is hereby amended by adding 17
thereto a new section to read as follows: 18
1. A prepaid limited health service organization that provides 19
coverage for prescription drugs shall calculate any cost-sharing 20
obligation imposed against an enrollee for a prescription drug 21
based on the net price paid for the drug . Any such cost -sharing 22
obligation must be calculated at the point-of-sale. 23
2. As used in this section: 24
(a) “Cost-sharing obligation” has the meaning ascribed to it in 25
section 6 of this act. 26
(b) “Net price paid” means the price paid for a prescription 27
drug by a prepaid limited health service organization or a 28
pharmacy benefit manager with which a prepaid limited health 29
service organization has contracted, inclusive of any rebates 30
received for the prescription drug. 31
(c) “Pharmacy benefit manager” has the meaning ascribed to 32
it in NRS 683A.174. 33
(d) “Rebate” has the meaning ascribed to it in section 13 of 34
this act. 35
Sec. 36. Chapter 695G of NRS is hereby amended by adding 36
thereto a new section to read as follows: 37
1. A managed care organization that offers or issues a health 38
care plan which provides coverage for prescription drugs shall 39
calculate any cost-sharing obligation imposed against an insured 40
for a prescription drug based on the net price paid for the drug . 41
Any such cost -sharing obligation must be calculated at the 42
point-of-sale. 43
2. As used in this section: 44

– 23 –

- *SB316_R4*
(a) “Cost-sharing obligation” has the meaning ascribed to it in 1
section 6 of this act. 2
(b) “Net price paid” means the price paid for a prescription 3
drug by a managed care organization or a pharmacy benefit 4
manager with which a managed care organization has contracted, 5
inclusive of any rebates received for the prescription drug. 6
(c) “Pharmacy benefit manager” has the mea ning ascribed to 7
it in NRS 683A.174. 8
(d) “Rebate” has the meaning ascribed to it in section 13 of 9
this act. 10
Sec. 37. NRS 695G.090 is hereby amended to read as follows: 11
695G.090 1. Except as otherwise provided in subsect ion 3, 12
the provisions of this chapter apply to each organization and insurer 13
that operates as a managed care organization and may include, 14
without limitation, an insurer that issues a policy of health 15
insurance, an insurer that issues a policy of individua l or group 16
health insurance, a carrier serving small employers, a fraternal 17
benefit society, a hospital or medical service corporation and a 18
health maintenance organization. 19
2. In addition to the provisions of this chapter, each managed 20
care organization shall comply with: 21
(a) The provisions of chapter 686A of NRS, including all 22
obligations and remedies set forth therein; and 23
(b) Any other applicable provision of this title. 24
3. The provisions of NRS 695G.127, 695G.1639, 695G.164, 25
695G.1645, 695G.167 a nd 695G.200 to 695G.230, inclusive, and 26
section 36 of this act do not apply to a managed care organization 27
that provides health care services to recipients of Medicaid under 28
the State Plan for Medicaid or insurance pursuant to the Children’s 29
Health Insurance Program pursuant to a contract with the Division 30
of Health Care Financing and Policy of the Department of Health 31
and Human Services. 32
4. The provisions of NRS 695C.1735 and 695G.1639 and 33
section 36 of this act do not apply to a managed care organization 34
that provides health care services to members of the Public 35
Employees’ Benefits Program. 36
5. Subsections 3 and 4 do not exempt a managed care 37
organization from any provision of this chapter for services 38
provided pursuant to any other contract. 39
Sec. 38. (Deleted by amendment.) 40
Sec. 39. NRS 239.010 is hereby amended to read as follows: 41
239.010 1. Except as otherwise provided in this section and 42
NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 43
49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 44
62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 45

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- *SB316_R4*
80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 1
87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 2
88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A .270, 3
116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 4
119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 5
120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 6
127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 7
130.712, 136.050, 159.044, 159A.044, 164.041, 172.075, 172.245, 8
176.01334, 176.01385, 176.015, 176.0625, 176.09129, 176.156, 9
176A.630, 178.39801, 178.4715, 178.5691, 178.5717, 179.495, 10
179A.070, 179A.165, 179D.160, 180.600, 200.3771, 200.3772, 11
200.5095, 200.604 , 202.3662, 205.4651, 209.392, 209.3923, 12
209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 13
213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 14
218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 218G.615, 15
224.240, 226.462, 226.796, 228.270, 228.450, 228.495, 228.570, 16
231.069, 231.1285, 231.1473, 232.1369, 233.190, 237.300, 17
239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 18
239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 19
239C.420, 240.007, 241.020, 241.030, 241.03 9, 242.105, 244.264, 20
244.335, 247.540, 247.545, 247.550, 247.560, 250.087, 250.130, 21
250.140, 250.145, 250.150, 268.095, 268.0978, 268.490, 268.910, 22
269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 23
281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 2 84.4086, 24
286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 25
293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 26
293.906, 293.908, 293.909, 293.910, 293B.135, 293D.510, 331.110, 27
332.061, 332.351, 333.333, 333.335, 338.070, 338.137 9, 338.1593, 28
338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 29
353A.049, 353A.085, 353A.100, 353C.240, 353D.250, 360.240, 30
360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 31
366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 32
379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 33
387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 34
388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 35
391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 36
392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 37
394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 38
396.159, 396.3295, 396.405, 396.525, 396.535, 396.9685, 39
398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 40
414.280, 416.070, 422.2 749, 422.305, 422A.342, 422A.350, 41
425.400, 427A.1236, 427A.872, 427A.940, 432.028, 432.205, 42
432B.175, 432B.280, 432B.290, 432B.4018, 432B.407, 432B.430, 43
432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 44
439.4941, 439.4988, 439.5282, 439.840, 439. 914, 439A.116, 45

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- *SB316_R4*
439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 1
441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 2
442.774, 445A.665, 445B.570, 445B.7773, 449.209, 449.245, 3
449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 4
453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 5
459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 6
463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 7
481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 8
483.575, 483.6 59, 483.800, 484A.469, 484B.830, 484B.833, 9
484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 10
571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 11
598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 12
604D.500, 604D.600, 612.265, 616B .012, 616B.015, 616B.315, 13
616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 14
624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 15
628B.760, 629.043, 629.047, 629.069, 630.133, 630.2671, 16
630.2672, 630.2673, 630.2687, 630.30665, 630 .336, 630A.327, 17
630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 18
632.3423, 632.405, 633.283, 633.301, 633.427, 633.4715, 633.4716, 19
633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 20
634A.185, 634B.730, 635.111, 635.158, 636.262, 636.342, 637.085, 21
637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 22
639.2485, 639.570, 640.075, 640.152, 640A.185, 640A.220, 23
640B.405, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 24
640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 25
641.221, 641.2215, 6 41A.191, 641A.217, 641A.262, 641B.170, 26
641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D.320, 27
642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 28
645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 29
645D.135, 645G.510, 645H.320, 645H.330, 6 47.0945, 647.0947, 30
648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 31
654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 32
669.285, 669A.310, 670B.680, 671.365, 671.415, 673.450, 673.480, 33
675.380, 676A.340, 676A.370, 677.243, 678A.47 0, 678C.710, 34
678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 35
679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 36
681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 37
687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 38
688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 39
692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 40
696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 41
711.600, and sections 1 and 19 of this act, sections 35, 38 and 41 of 42
chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, 43
Statutes of Nevada 2013 and unless otherwise declared by law to be 44
confidential, all public books and public records of a governmental 45

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- *SB316_R4*
entity must be open at all times during office hours to inspe ction by 1
any person, and may be fully copied or an abstract or memorandum 2
may be prepared from those public books and public records. Any 3
such copies, abstracts or memoranda may be used to supply the 4
general public with copies, abstracts or memoranda of the records or 5
may be used in any other way to the advantage of the governmental 6
entity or of the general public. This section does not supersede or in 7
any manner affect the federal laws governing copyrights or enlarge, 8
diminish or affect in any other manner the rights of a person in any 9
written book or record which is copyrighted pursuant to federal law. 10
2. A governmental entity may not reject a book or record 11
which is copyrighted solely because it is copyrighted. 12
3. A governmental entity that has legal custody or control of a 13
public book or record shall not deny a request made pursuant to 14
subsection 1 to inspect or copy or receive a copy of a public book or 15
record on the basis that the requested public book or record contains 16
information that is confiden tial if the governmental entity can 17
redact, delete, conceal or separate, including, without limitation, 18
electronically, the confidential information from the information 19
included in the public book or record that is not otherwise 20
confidential. 21
4. If requested, a governmental entity shall provide a copy of a 22
public record in an electronic format by means of an electronic 23
medium. Nothing in this subsection requires a governmental entity 24
to provide a copy of a public record in an electronic format or by 25
means of an electronic medium if: 26
(a) The public record: 27
(1) Was not created or prepared in an electronic format; and 28
(2) Is not available in an electronic format; or 29
(b) Providing the public record in an electronic format or by 30
means of an electronic medium would: 31
(1) Give access to proprietary software; or 32
(2) Require the production of information that is confidential 33
and that cannot be redacted, deleted, concealed or separated from 34
information that is not otherwise confidential. 35
5. An officer, employee or agent of a governmental entity who 36
has legal custody or control of a public record: 37
(a) Shall not refuse to provide a copy of that public record in the 38
medium that is requested because the officer, employee or agent has 39
already prepared or wou ld prefer to provide the copy in a different 40
medium. 41
(b) Except as otherwise provided in NRS 239.030, shall, upon 42
request, prepare the copy of the public record and shall not require 43
the person who has requested the copy to prepare the copy himself 44
or herself. 45

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Sec. 40. (Deleted by amendment.) 1
Sec. 41. NRS 287.04335 is hereby amended to read as 2
follows: 3
287.04335 If the Board provides health insurance through a 4
plan of self -insurance, it sh all comply with the provisions of 5
NRS 439.581 to 439.597, inclusive, 686A.135, 687B.352, 6
687B.409, 687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 7
689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 8
695G.1635, 695G.164, 695G.1645, 695G.1665, 6 95G.167, 9
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 10
695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, 11
inclusive, other than section 36 of this act, 695G.241 to 695G.310, 12
inclusive, 695G.405 and 695G.415, in the same manner as an 13
insurer that is licensed pursuant to title 57 of NRS is required to 14
comply with those provisions. 15
Sec. 41.5. Section 17 of Assembly Bill No. 343 of this session 16
is hereby amended to read as follows: 17
Sec. 17. 1. A hosp ital shall not take any action 18
described in subsection 2 with regard to covered medical 19
debt incurred by a medical debtor while the hospital is not 20
in compliance with any provision of section 13, 14 or 15 of 21
this act or 45 C.F.R. § 180.40, 180.50 or 180.60. 22
2. A hospital shall not, with regard to any covered 23
medical debt described in subsection 1: 24
(a) Refer the covered medical debt to a collection agency 25
or other third party for collection; 26
(b) File a civil action or seek arbitration or mediation to 27
collect the covered medical debt; or 28
(c) Directly or indirectly cause the reporting of the 29
covered medical debt to a reporting agency. 30
3. If a medical debtor believes that a hospital has taken 31
an action described in subsection 2 in violation of 32
subsection 1 with respect to any covered medical debt owed 33
by the medical debtor, the medical debtor may file a claim 34
with the Bureau of Consumer Protection in the Office of the 35
Attorney General. A medical debtor who files such a claim 36
shall immediately notify the hospital that he or she has filed 37
the claim. 38
4. Upon the filing of a claim pursuant to subsection 3, 39
the Bureau of Consumer Protection shall investigate the 40
claim. The hospital shall not take any action described in 41
subsection 2 to collect the covered medical debt that is the 42
subject of the investigation while the investigation is 43
pending. 44

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- *SB316_R4*
5. If, at the conclusion of an investigation pursuant to 1
subsection 4, the Bureau of Consumer Protection 2
determines that the hospital has taken an action described 3
in subsection 2 in violation of subsection 1, the hospital 4
shall cancel the covered medical debt that is the subject of 5
the investigation and any related medical debt and refund 6
any amount of the covered medical debt or any related 7
medical debt which has been paid by the medical debtor. 8
6. A knowing violation of this section constitutes a 9
deceptive trade practice for the purposes of NRS 598.0903 to 10
598.0999, inclusive. 11
7. As used in this section: 12
(a) “Covered bill or group of bills” means a bill or 13
group of bills that includes any charge for a medical 14
service, product or device which is greater than the amount 15
published for that medical service, product or device 16
pursuant to section 13, 14 or 15 of this act or 45 C.F.R. § 17
180.40, 180.50 or 180.60, as applicable. 18
(b) “Covered medical debt” means medical debt owed by 19
a medical debtor which was originally included in a covered 20
bill or group of bills issued to the medical debtor. 21
(c) “Reporting agency” has the meaning ascribed to it in 22
NRS 598C.100. 23
Sec. 41.7. Section 26 of Assembly Bill No. 343 of this session 24
is hereby amended to read as follows: 25
Sec. 26. 1. The provisions of section 17 of this act 26
apply to any covered medical debt incurred before, on or after 27
January 1, 2026. 28
2. The provisions of section 22 of this act apply to any 29
medical debt incurred on or after January 1, 2026. 30
3. As used in this section [, “medical] : 31
(a) “Covered medical debt” has the meaning ascribed to 32
it in section 17 of Assembly B ill No. 343 of this session, as 33
amended by section 41.5 of this act. 34
(b) “Medical debt” has the meaning ascribed to it in 35
[NRS 649.036.] section 7 of Assembly Bill No. 343 of this 36
session. 37
Sec. 42. (Deleted by amendment.) 38
Sec. 43. The amendatory provisions of this act do not apply to 39
any contract or other agreement entered into before January 1, 2026, 40
but apply to the renewal of any such contract or other agreement. 41
Sec. 44. The provisions of subsection 1 of NRS 218D.380 do 42
not apply to any provision of this act which adds or revises a 43
requirement to submit a report to the Legislature. 44
Sec. 45. (Deleted by amendment.) 45

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- *SB316_R4*
Sec. 46. 1. This section becomes effective upon passage and 1
approval. 2
2. Sections 1 to 16, inclusive, and 17 to 24, inclusive, 38, 39, 3
40 and 42 to 45, inclusive, of this act become effective: 4
(a) Upon passage and approval for the purpose of adopting any 5
regulations and performing any other preparatory administrative 6
tasks that are necessary to carry out the provisions of this act; and 7
(b) On January 1, 2026, for all other purposes. 8
3. Sections 41.5 and 41.7 of this act become effective: 9
(a) Upon passage and approval for the purpose of adopting any 10
regulations and performing any other preparatory administrative 11
tasks that are necessary to carry out the provisions of this act; and 12
(b) On January 1, 2026, for all other purposes, 13
 if and only if Assembly Bill No. 343 of this session is enacted by 14
the Legislature and approved by the Governor. 15
4. Sections 16.5, 25 to 37, inclusive, and 41 of this act become 16
effective: 17
(a) Upon passage and approval for the purpose of adopting a ny 18
regulations and performing any other preparatory administrative 19
tasks that are necessary to carry out the provisions of this act; and 20
(b) On January 1, 2028, for all other purposes. 21

H