Establishes provisions relating to health insurance. (BDR 57-1083)

S.B. 377

- *SB377*

SENATE BILL NO. 377–SENATOR STEINBECK

MARCH 17, 2025
____________

Referred to Committee on Commerce and Labor

SUMMARY—Establishes provisions relating to health insurance.
(BDR 57-1083)

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

CONTAINS UNFUNDED MANDATE (§ 13)
(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 insurance; requiring certain policies of health
insurance to include coverage for certain alternatives to
opioids; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Existing law requires public and private policies of insurance regulated under 1
Nevada law and employers who provide such insurance for their employees to 2
include coverage for drugs to: (1) support safe withdrawal from substance use 3
disorder; and (2) provide medication -assisted treatment for opioid use disorder. 4
(NRS 287.010, 287.04335, 422.4025, 608.1555, 689A.0459, 689B.0319, 5
689C.1665, 695A.1874, 695B.19197, 695C.050, 695C.1699, 695G.1719) Sections 6
2, 4-10 and 12-15 of this bill require certain public and private policies of health 7
insurance to cover drugs that are alternatives to opioids for purposes for which 8
opioids are commonly used. Sections 1, 2, 4-10, 12-14 and 16 of this bill: (1) 9
prohibit certain insurers from imposing certain other conditions on covere d opioid 10
alternatives that are not imposed on opioids; and (2) require such an insurer to 11
exempt an insured from medical management techniques that would otherwise 12
apply to an alternative to an opioid if the provider of health care prescribing or 13
administering the alternative confirms that the alternative is an appropriate 14
treatment for the patient. Section 3 of this bill authorizes the Commissioner of 15
Insurance to require certain policies of health insurance issued by a domestic 16
insurer to a person who resides in another state to include the coverage required by 17
section 2. Section 11 of this bill authorizes the Commissioner to suspend or revoke 18
the certification of a health maintenance organization that fails to co mply with the 19
requirements of section 9. The Commissioner would also be authorized to take 20
such actions against other health insurers who fail to comply with the requirements 21
of sections 2, 4-10 and 12. (NRS 680A.200) 22

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

Section 1. NRS 687B.225 is hereby amended to read as 1
follows: 2
687B.225 1. Except as otherwise provided in NRS 3
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 4
689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 5
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 6
689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 7
695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 8
695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 9
695B.1925, 695B.1942, 695C.1696, 695C.1699, 69 5C.1713, 10
695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 11
695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 12
695G.1719 and 695G.177 , and sections 2, 4, 5, 7, 8, 9 and 12 of 13
this act, any contract for group, blanket or individual health 14
insurance or any contract by a nonprofit hospital, medical or dental 15
service corporation or organization for dental care which provides 16
for payment of a certain part of medical or dental care may require 17
the insured or member to obtain prior authorization for that care 18
from the insurer or organization. The insurer or organization shall: 19
(a) File its procedure for obtaining approval of care pursuant to 20
this section for approval by the Commissioner; and 21
(b) Unless a shorter time period is prescribed by a specific 22
statute, including, without limitation, NRS 689A.0446, 689B.0361, 23
689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, 24
respond to any request for approval by the insured or member 25
pursuant to this section within 20 days after it receives the request. 26
2. The procedure for prior authorization may not discriminate 27
among persons licensed to provide the covered care. 28
Sec. 2. Chapter 689A of NRS is hereby amended by adding 29
thereto a new section to read as follows: 30
1. An insurer that offers or issues a policy of health 31
insurance shall include in the policy coverage for at least one 32
alternative to an opioid that is effective for each purpose for 33
which: 34
(a) An opioid is commonly used; and 35
(b) A non-opioid alternative is available. 36
2. An insurer shall not: 37
(a) Require prior authorization for an alternative to an opioid 38
if prior authorization would not be required for an opioid under 39
the same circumstances; or 40

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(b) Impose other requirements on an alternative to an opioid 1
that would n ot be imposed on an opioid used under the same 2
circumstances. 3
3. An insurer shall exempt an insured from any medical 4
management techniques that would otherwise apply to the benefits 5
described in subsection 1 if the provider of health care who 6
prescribes or administers an alternative to an opioid confirms that, 7
in the professional judgment of the provider of health care, the 8
alternative to an opioid is appropriate for the treatment of the 9
patient. 10
4. A policy of health insurance subject to the provision s of 11
this chapter that is delivered, issued for delivery or renewed on or 12
after January 1, 2026, has the legal effect of including the 13
coverage required by subsection 1, and any provision of the policy 14
that conflict with the provisions of this section is void. 15
5. As used in this section: 16
(a) “Medical management technique” means a practice which 17
is used to control the cost or utilization of health care services or 18
prescription drug use. The term includes, without limitation, the 19
use of step therapy, prio r authorization or categorizing drugs and 20
devices based on cost, type or method of administration. 21
(b) “Provider of health care” has the meaning ascribed to it in 22
NRS 629.031. 23
Sec. 3. NRS 689A.330 is hereby amended to read as follows: 24
689A.330 If any policy is issued by a domestic insurer for 25
delivery to a person residing in another state, and if the insurance 26
commissioner or corresponding public officer of that other state has 27
informed the Commissioner that the policy is not subject to approval 28
or disapproval by that officer, the Commissioner may by ruling 29
require that the policy meet the standards set forth in NRS 689A.030 30
to 689A.320, inclusive [.] , and section 2 of this act. 31
Sec. 4. Chapter 689B of NRS is hereby amended by adding 32
thereto a new section to read as follows: 33
1. An insurer that offers or issues a policy of group health 34
insurance shall include in the policy coverage for at least one 35
alternative to an opioid that is effective for each purpose for 36
which: 37
(a) An opioid is commonly used; and 38
(b) A non-opioid alternative is available. 39
2. An insurer shall not: 40
(a) Require prior authorization for an alternative to an opioid 41
if prior authorization would not be required for an opioid under 42
the same circumstances; or 43

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(b) Impose other requirements on an alternative to an opioid 1
that would not be imposed on an opioid us ed under the same 2
circumstances. 3
3. An insurer shall exempt an insured from any medical 4
management techniques that would otherwise apply to the benefits 5
described in subsection 1 if the provider of health care who 6
prescribes or administers an alternative to an opioid confirms that, 7
in the professional judgment of the provider of health care, the 8
alternative to an opioid is appropriate for the treatment of the 9
patient. 10
4. A policy of group health insurance subj ect to the 11
provisions of this chapter that is delivered, issued for delivery or 12
renewed on or after January 1, 2026, has the legal effect of 13
including the coverage required by subsection 1, and any 14
provisions of the policy that conflict with the provisions of this 15
section is void. 16
5. As used in this section: 17
(a) “Medical management technique” means a practice which 18
is used to control the cost or utilization of health care services or 19
prescription drug use. The term includes, without limitation, the 20
use of step therapy, prior authorization or categorizing drugs and 21
devices based on cost, type or method of administration. 22
(b) “Provider of health care” has the meaning ascribed to it in 23
NRS 629.031. 24
Sec. 5. Chapter 689C of NRS is hereby amended by adding 25
thereto a new section to read as follows: 26
1. A carrier that offers or issues a health benefit plan shall 27
include in the plan coverage for at least one alternative to an 28
opioid that is effective for each purpose for which: 29
(a) An opioid is commonly used; and 30
(b) A non-opioid alternative is available. 31
2. A carrier shall not: 32
(a) Require prior authorization for an alternative to an opioid 33
if prior authorization would not be required for an opioid under 34
the same circumstances; or 35
(b) Impose other requirements on an alternative to an opioid 36
that would not be imposed on an opioid used under the same 37
circumstances. 38
3. A carrier shall exempt an insured from any medical 39
management techniques that would otherwise apply to the benefits 40
described in subsection 1 if the provider of health care who 41
prescribes or administers an alternative to an opioid confirms that, 42
in the professional judgment of the provider of health care, the 43
alternative to an opioid is appropriate for the t reatment of the 44
patient. 45

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4. A health benefit plan subject to the provisions of this 1
chapter that is delivered, issued for delivery or renewed on or after 2
January 1, 2026, has the legal effect of including the coverage 3
required by subsection 1, and any pr ovisions of the plan that 4
conflict with the provisions of this section is void. 5
5. As used in this section: 6
(a) “Medical management technique” means a practice which 7
is used to control the cost or utilization of health care services or 8
prescription dru g use. The term includes, without limitation, the 9
use of step therapy, prior authorization or categorizing drugs and 10
devices based on cost, type or method of administration. 11
(b) “Provider of health care” has the meaning ascribed to it in 12
NRS 629.031. 13
Sec. 6. NRS 689C.425 is hereby amended to read as follows: 14
689C.425 A voluntary purchasing group and any contract 15
issued to such a group pursuant to NRS 689C.360 to 689C.600, 16
inclusive, are subject to the provisions of NRS 6 89C.015 to 17
689C.355, inclusive, and section 5 of this act, to the extent 18
applicable and not in conflict with the express provisions of NRS 19
687B.408 and 689C.360 to 689C.600, inclusive. 20
Sec. 7. Chapter 695A of NRS is hereby amended by adding 21
thereto a new section to read as follows: 22
1. A society that offers or issues a benefit contract shall 23
include in the contract coverage for at least one alternative to an 24
opioid that is effective for each purpose for which: 25
(a) An opioid is commonly used; and 26
(b) A non-opioid alternative is available. 27
2. A society shall not: 28
(a) Require prior authorization for an alternative to an opioid 29
if prior authorization would not be required for an opioid under 30
the same circumstances; or 31
(b) Impose other requirements on an alternative to an opioid 32
that would not be imposed on an opioid used under the same 33
circumstances. 34
3. A society shall exempt an insured from any medical 35
management techniques that would otherwise apply to the benefits 36
described in subsection 1 if the provider of health care who 37
prescribes or administers an alternative to an opioid confirms that, 38
in the professional judgment of the provider of health care, the 39
alternative to an opioid is appropriate for the treatment of the 40
patient. 41
4. A benefit contract subject to the provisi ons of this chapter 42
that is delivered, issued for delivery or renewed on or after 43
January 1, 2026, has the legal effect of including the coverage 44

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required by subsection 1, and any provisions of the contract that 1
conflict with the provisions of this section is void. 2
5. As used in this section: 3
(a) “Medical management technique” means a practice which 4
is used to control the cost or utilization of health care services or 5
prescription drug use. The term includes, without limitation, the 6
use of step therapy, prior authorization or categorizing drugs and 7
devices based on cost, type or method of administration. 8
(b) “Provider of health care” has the meaning ascribed to it in 9
NRS 629.031. 10
Sec. 8. Chapter 695B of NRS is hereby am ended by adding 11
thereto a new section to read as follows: 12
1. A hospital or medical services corporation that offers or 13
issues a policy of health insurance shall include in the policy 14
coverage for at least one alternative to an opioid that is effective 15
for each purpose for which: 16
(a) An opioid is commonly used; and 17
(b) A non-opioid alternative is available. 18
2. A hospital or medical services corporation shall not: 19
(a) Require prior authorization for an alternative to an opioid 20
if prior authorization would not be required for an opioid under 21
the same circumstances; or 22
(b) Impose other requirements on an alternative to an opioid 23
that would not be imposed on an opioid used under the same 24
circumstances. 25
3. A hospital or medical services corporation shall exempt an 26
insured from any medical management techniques that woul d 27
otherwise apply to the benefits described in subsection 1 if the 28
provider of health care who prescribes or administers an 29
alternative to an opioid confirms that, in the professional 30
judgment of the provider of health care, the alternative to an 31
opioid is appropriate for the treatment of the patient. 32
4. A policy of health insurance subject to the provisions of 33
this chapter that is delivered, issued for delivery or renewed on or 34
after January 1, 2026, has the legal effect of including the 35
coverage require d by subsection 1, and any provisions of the 36
policy that conflict with the provisions of this section is void. 37
5. As used in this section: 38
(a) “Medical management technique” means a practice which 39
is used to control the cost or utilization of health car e services or 40
prescription drug use. The term includes, without limitation, the 41
use of step therapy, prior authorization or categorizing drugs and 42
devices based on cost, type or method of administration. 43
(b) “Provider of health care” has the meaning ascr ibed to it in 44
NRS 629.031. 45

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Sec. 9. Chapter 695C of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. A health maintenance organization that offers or issues a 3
health care plan shall include in the plan coverage for at least one 4
alternative to an opioid that is effective for each purpose for 5
which: 6
(a) An opioid is commonly used; and 7
(b) A non-opioid alternative is available. 8
2. A health maintenance organization shall not: 9
(a) Require prior authorization for an alternative to an opioid 10
if prior authorization would not be required for an opioid under 11
the same circumstances; or 12
(b) Impose other requirements on an alternative to an opioid 13
that would not be imposed on an opioid used under the s ame 14
circumstances. 15
3. A health maintenance organization shall exempt an 16
enrollee from any medical management techniques that would 17
otherwise apply to the benefits described in subsection 1 if the 18
provider of health care who prescribes or administers an 19
alternative to an opioid confirms that, in the professional 20
judgment of the provider of health care, the alternative to an 21
opioid is appropriate for the treatment of the patient. 22
4. A health care plan subject to the provisions of this chapter 23
that is del ivered, issued for delivery or renewed on or after 24
January 1, 2026, has the legal effect of including the coverage 25
required by subsection 1, and any provisions of the plan that 26
conflict with the provisions of this section is void. 27
5. As used in this section: 28
(a) “Medical management technique” means a practice which 29
is used to control the cost or utilization of health care services or 30
prescription drug use. The term includes, without limitation, the 31
use of step therapy, prior authorization or categorizing drugs and 32
devices based on cost, type or method of administration. 33
(b) “Provider of health care” has the meaning ascribed to it in 34
NRS 629.031. 35
Sec. 10. 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.17 03, 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 do not apply to a health maintenance 10
organization that provides health care services through m anaged 11
care to recipients of Medicaid under the State Plan for Medicaid or 12
insurance pursuant to the Children’s Health Insurance Program 13
pursuant to a contract with the Division of Health Care Financing 14
and Policy of the Department of Health and Human Serv ices. This 15
subsection does not exempt a health maintenance organization from 16
any provision of this chapter for services provided pursuant to any 17
other contract. 18
5. The provisions of NRS 695C.16932 to 695C.1699, 19
inclusive, and section 9 of this act, 695C.1701, 695C.1708, 20
695C.1728, 695C.1731, 695C.17333, 695C.17345, 695C.17347, 21
695C.1736 to 695C.1745, inclusive, 695C.1757 and 695C.204 apply 22
to a health mainte nance organization that provides health care 23
services through managed care to recipients of Medicaid under the 24
State Plan for Medicaid. 25
6. The provisions of NRS 695C.17095 do not apply to a health 26
maintenance organization that provides health care services to 27
members of the Public Employees’ Benefits Program. This 28
subsection does not exempt a health maintenance organization from 29
any provision of this chapter for services provided pursuant to any 30
other contract. 31
7. The provisions of NRS 695C.1735 d o not apply to a health 32
maintenance organization that provides health care services to: 33
(a) The officers and employees, and the dependents of officers 34
and employees, of the governing body of any county, school district, 35
municipal corporation, political su bdivision, public corporation or 36
other local governmental agency of this State; or 37
(b) Members of the Public Employees’ Benefits Program. 38
 This subsection does not exempt a health maintenance 39
organization from any provision of this chapter for services 40
provided pursuant to any other contract. 41
Sec. 11. NRS 695C.330 is hereby amended to read as follows: 42
695C.330 1. The Commissioner may suspend or revoke any 43
certificate of authority issued to a health maintenance organization 44

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

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(k) The health maintenance organization has otherwis e failed to 1
comply substantially with the provisions of this chapter. 2
2. A certificate of authority must be suspended or revoked only 3
after compliance with the requirements of NRS 695C.340. 4
3. If the certificate of authority of a health maintenance 5
organization is suspended, the health maintenance organization shall 6
not, during the period of that suspension, enroll any additional 7
groups or new individual contracts, unless those groups or persons 8
were contracted for before the date of suspension. 9
4. If the certificate of authority of a health maintenance 10
organization is revoked, the organization shall proceed, immediately 11
following the effective date of the order of revocation, to wind up its 12
affairs and shall conduct no further business except as may b e 13
essential to the orderly conclusion of the affairs of the organization. 14
It shall engage in no further advertising or solicitation of any kind. 15
The Commissioner may, by written order, permit such further 16
operation of the organization as the Commissioner may find to be in 17
the best interest of enrollees to the end that enrollees are afforded 18
the greatest practical opportunity to obtain continuing coverage for 19
health care. 20
Sec. 12. Chapter 695G of NRS is hereby amended by addi ng 21
thereto a new section to read as follows: 22
1. A managed care organization that offers or issues a health 23
care plan shall include in the plan coverage for at least one 24
alternative to an opioid that is effective for each purpose for 25
which: 26
(a) An opioid is commonly used; and 27
(b) A non-opioid alternative is available. 28
2. A managed care organization shall not: 29
(a) Require prior authorization for an alternative to an opioid 30
if prior authorization would not be required for an opioid under 31
the same circumstances; or 32
(b) Impose other requirements on an alternative to an opioid 33
that would not be imposed on an opioid used under the same 34
circumstances. 35
3. A managed care organization shall exempt an insured 36
from any medical management techniq ues that would otherwise 37
apply to the benefits described in subsection 1 if the provider of 38
health care who prescribes or administers an alternative to an 39
opioid confirms that, in the professional judgment of the provider 40
of health care, the alternative to an opioid is appropriate for the 41
treatment of the patient. 42
4. A health care plan subject to the provisions of this chapter 43
that is delivered, issued for delive ry or renewed on or after 44
January 1, 2026, has the legal effect of including the coverage 45

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required by subsection 1, and any provisions of the plan that 1
conflict with the provisions of this section is void. 2
5. As used in this section: 3
(a) “Medical management technique” means a practice which 4
is used to control the cost or utilization of health care services or 5
prescription drug use. The term includes, without limitation, the 6
use of step therapy, prior authorization or categorizing drugs and 7
devices based on cost, type or method of administration. 8
(b) “Provider of health care” has the meaning ascribed to it in 9
NRS 629.031. 10
Sec. 13. NRS 287.010 is hereby amended to read as follows: 11
287.010 1. The governing body of any co unty, school 12
district, municipal corporation, political subdivision, public 13
corporation or other local governmental agency of the State of 14
Nevada may: 15
(a) Adopt and carry into effect a system of group life, accident 16
or health insurance, or any combination thereof, for the benefit of its 17
officers and employees, and the dependents of officers and 18
employees who elect to accept the insurance and who, where 19
necessary, have authorized the governing body to make deductions 20
from their compensation for the payment of premiums on the 21
insurance. 22
(b) Purchase group policies of life, accident or health insurance, 23
or any combination thereof, for the benefit of such officers and 24
employees, and the dependents of such officers and employees, as 25
have authorized the purchase , from insurance companies authorized 26
to transact the business of such insurance in the State of Nevada, 27
and, where necessary, deduct from the compensation of officers and 28
employees the premiums upon insurance and pay the deductions 29
upon the premiums. 30
(c) Provide group life, accident or health coverage through a 31
self-insurance reserve fund and, where necessary, deduct 32
contributions to the maintenance of the fund from the compensation 33
of officers and employees and pay the deductions into the fund. The 34
money accumulated for this purpose through deductions from the 35
compensation of officers and employees and contributions of the 36
governing body must be maintained as an internal service fund as 37
defined by NRS 354.543. The money must be deposited in a state or 38
national bank or credit union authorized to transact business in the 39
State of Nevada. Any independent administrator of a fund created 40
under this section is subject to the licensing requirements of chapter 41
683A of NRS, and must be a resident of this State. Any contract 42
with an independent administrator must be approved by the 43
Commissioner of Insurance as to the reasonableness of 44
administrative charges in relation to contributions collected and 45

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benefits provided. The provisions of NRS 439.581 to 439.597, 1
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 2
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs 3
(b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 4
and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 5
689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 6
and 689B.500 , and section 4 of this act apply to coverage provided 7
pursuant to this paragraph, except that the provisions of NRS 8
689B.0378, 689B.03785 and 689B.500 only apply to coverage for 9
active officers and employees of the governing body, or the 10
dependents of such officers and employees. 11
(d) Defray part or all of the cost of maintenance of a self -12
insurance fund or of the premiums upon insurance. The money for 13
contributions must be budgeted for in accordance with the laws 14
governing the county, school district, municipal corporation, 15
political subdivision, public corporation or other local governmental 16
agency of the State of Nevada. 17
2. If a school district offers group insurance to its officers and 18
employees pursuant to this section, members of the board of trustees 19
of the school district must not be excluded from participating in the 20
group insurance. If the amount of the deductions from compensation 21
required to pay for the group insurance exceeds the compensation to 22
which a trustee is entitled, the difference must be paid by the trustee. 23
3. In any county in which a legal services organization exists, 24
the governing body of the county, or of any school district, 25
municipal corporation, political subdivision, public corporation or 26
other local governmental agency of the State of Nevada in the 27
county, may enter into a contract with the legal services 28
organization pursuant to which the officers and employees of the 29
legal services organization, and the dependents of those officers and 30
employees, are eligible for any life, accident or health insurance 31
provided pursuant to this section to the officers and employ ees, and 32
the dependents of the officers and employees, of the county, school 33
district, municipal corporation, political subdivision, public 34
corporation or other local governmental agency. 35
4. If a contract is entered into pursuant to subsection 3, the 36
officers and employees of the legal services organization: 37
(a) Shall be deemed, solely for the purposes of this section, to be 38
officers and employees of the county, school district, municipal 39
corporation, political subdivision, public corporation or other lo cal 40
governmental agency with which the legal services organization has 41
contracted; and 42
(b) Must be required by the contract to pay the premiums or 43
contributions for all insurance which they elect to accept or of which 44
they authorize the purchase. 45

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5. A contract that is entered into pursuant to subsection 3: 1
(a) Must be submitted to the Commissioner of Insurance for 2
approval not less than 30 days before the date on which the contract 3
is to become effective. 4
(b) Does not become effective unless approved b y the 5
Commissioner. 6
(c) Shall be deemed to be approved if not disapproved by the 7
Commissioner within 30 days after its submission. 8
6. As used in this section, “legal services organization” means 9
an organization that operates a program for legal aid and receives 10
money pursuant to NRS 19.031. 11
Sec. 14. NRS 287.04335 is hereby amended to read as 12
follows: 13
287.04335 If the Board provides health insurance through a 14
plan of self -insurance, it shall comply with the provisions of NRS 15
439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 16
687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 17
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 18
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 19
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 20
695G.174, inclusive, and section 12 of this act, 695G.176, 21
695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 22
695G.310, inclusive, 695G.405 and 695G.415, in the same manner 23
as an insurer that is licensed pursuant to title 57 of NRS is required 24
to comply with those provisions. 25
Sec. 15. NRS 422.4025 is hereby amended to read as follows: 26
422.4025 1. The Department shall: 27
(a) By regulation, develop a list of preferred prescription drugs 28
to be used for the Medicaid progra m and the Children’s Health 29
Insurance Program, and each public or nonprofit health benefit plan 30
that elects to use the list of preferred prescription drugs as its 31
formulary pursuant to NRS 287.012, 287.0433 or 687B.407; and 32
(b) Negotiate and enter into ag reements to purchase the drugs 33
included on the list of preferred prescription drugs on behalf of the 34
health benefit plans described in paragraph (a) or enter into a 35
contract pursuant to NRS 422.4053 with a pharmacy benefit 36
manager, health maintenance organ ization or one or more public or 37
private entities in this State, the District of Columbia or other states 38
or territories of the United States, as appropriate, to negotiate such 39
agreements. 40
2. The Department shall, by regulation, establish a list of 41
prescription drugs which must be excluded from any restrictions that 42
are imposed by the Medicaid program on drugs that are on the list of 43
preferred prescription drugs established pursuant to subsecti on 1. 44

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The list established pursuant to this subsection must include, 1
without limitation: 2
(a) Prescription drugs that are prescribed for the treatment of the 3
human immunodeficiency virus, including, without limitation, 4
antiretroviral medications; 5
(b) Antirejection medications for organ transplants; 6
(c) Antihemophilic medications; and 7
(d) Any prescription drug which the Board identifies as 8
appropriate for exclusion from any restrictions that are imposed by 9
the Medicaid program on drugs that are on the lis t of preferred 10
prescription drugs. 11
3. The regulations must provide that the Board makes the final 12
determination of: 13
(a) Whether a class of therapeutic prescription drugs is included 14
on the list of preferred prescription drugs and is excluded from any 15
restrictions that are imposed by the Medicaid program on drugs that 16
are on the list of preferred prescription drugs; 17
(b) Which therapeutically equivalent prescription drugs will be 18
reviewed for inclusion on the list of preferred prescription drugs and 19
for exclusion from any restrictions that are imposed by the Medicaid 20
program on drugs that are on the list of preferred prescription drugs; 21
and 22
(c) Which prescription drugs should be excluded from any 23
restrictions that are imposed by the Medicaid program on dr ugs that 24
are on the list of preferred prescription drugs based on continuity of 25
care concerning a specific diagnosis, condition, class of therapeutic 26
prescription drugs or medical specialty. 27
4. The list of preferred prescription drugs established pursuan t 28
to subsection 1 must include, without limitation: 29
(a) Any prescription drug determined by the Board to be 30
essential for treating sickle cell disease and its variants; [and] 31
(b) Prescription drugs to prevent the acquisition of human 32
immunodeficiency virus [.] ; and 33
(c) Alternatives to opioids for purposes for which opioids 34
would normally be used. 35
5. The regulations must provide that each new pharmaceutical 36
product and each existing pharmaceutical product for which there is 37
new clinical evidence supporting its inclusion on the list of preferred 38
prescription drugs must be made available pursuant to the Medicaid 39
program with prior authorization until the Board reviews the product 40
or the evidence. 41
6. The Medicaid program must cover a prescription drug that is 42
not included on the list of preferred prescription drugs as if the drug 43
were included on that list if: 44
(a) The drug is: 45

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(1) Used to treat hepatitis C; 1
(2) Used to provide medication -assisted treatment for opioid 2
use disorder; 3
(3) Used to supp ort safe withdrawal from substance use 4
disorder; or 5
(4) In the same class as a drug on the list of preferred 6
prescription drugs; and 7
(b) All preferred prescription drugs within the same class as the 8
drug are unsuitable for a recipient of Medicaid because: 9
(1) The recipient is allergic to all preferred prescription drugs 10
within the same class as the drug; 11
(2) All preferred prescription drugs within the same class as 12
the drug are contraindicated for the recipient or are likely to interact 13
in a harmful manner with another drug that the recipient is taking; 14
(3) The recipient has a history of adverse reactions to all 15
preferred prescription drugs within the same class as the drug; or 16
(4) The drug has a unique indication that is supported by 17
peer-reviewed clinical evidence or approved by the United States 18
Food and Drug Administration. 19
7. The Medicaid program must automatically cover any typical 20
or atypical antipsychotic medication or anticonvulsant medication 21
that is not on the list of prefe rred prescription drugs upon the 22
demonstrated therapeutic failure of one drug on that list to 23
adequately treat the condition of a recipient of Medicaid. 24
8. On or before February 1 of each year, the Department shall: 25
(a) Compile a report concerning the a greements negotiated 26
pursuant to paragraph (b) of subsection 1 and contracts entered into 27
pursuant to NRS 422.4053 which must include, without limitation, 28
the financial effects of obtaining prescription drugs through those 29
agreements and contracts, in tota l and aggregated separately for 30
agreements negotiated by the Department, contracts with a 31
pharmacy benefit manager, contracts with a health maintenance 32
organization and contracts with public and private entities from this 33
State, the District of Columbia an d other states and territories of the 34
United States; and 35
(b) Post the report on an Internet website maintained by the 36
Department and submit the report to the Director of the Legislative 37
Counsel Bureau for transmittal to: 38
(1) In odd-numbered years, the Legislature; or 39
(2) In even-numbered years, the Legislative Commission. 40
Sec. 16. NRS 422.403 is hereby amended to read as follows: 41
422.403 1. The Department shall, by regulation, establish and 42
manage the use by the Medi caid program of step therapy and prior 43
authorization for prescription drugs. 44
2. The Drug Use Review Board shall: 45

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(a) Advise the Department concerning the use by the Medicaid 1
program of step therapy and prior authorization for prescription 2
drugs; 3
(b) Develop step therapy protocols and prior authorization 4
policies and procedures for use by the Medicaid program for 5
prescription drugs; and 6
(c) Review and approve, based on clinical evidence and best 7
clinical practice guidelines and without consideration o f the cost of 8
the prescription drugs being considered, step therapy protocols used 9
by the Medicaid program for prescription drugs. 10
3. The step therapy protocol established pursuant to this section 11
must not apply to [a] : 12
(a) A drug approved by the Food and Drug Administration that 13
is prescribed to treat a psychiatric condition of a recipient of 14
Medicaid, if: 15
[(a)] (1) The drug has been approved by the Food and Drug 16
Administration with indications for the psychiatric condition of the 17
insured or the use o f the drug to treat that psychiatric condition is 18
otherwise supported by medical or scientific evidence; 19
[(b)] (2) The drug is prescribed by: 20
[(1)] (I) A psychiatrist; 21
[(2)] (II) A physician assistant under the supervision of a 22
psychiatrist; 23
[(3)] (III) An advanced practice registered nurse who has 24
the psychiatric training and experience prescribed by the State 25
Board of Nursing pursuant to NRS 632.120; or 26
[(4)] (IV) A primary care provider that is providing care to 27
an insured in consultation with a practitioner listed in [subparagraph 28
(1), (2) or (3), ] sub-subparagraph (I), (II) or (III), if the closest 29
practitioner listed in [subparagraph (1), (2) or (3) ] sub-30
subparagraph (I), (II) or (III) who participates in Medicaid is 31
located 60 miles or more from the residence of the recipient; and 32
[(c)] (3) The practitioner listed in [paragraph (b)] subparagraph 33
(1) who prescribed the drug knows, based on the medical history of 34
the recipient, or reasonably expects each alternative drug that is 35
required to b e used earlier in the step therapy protocol to be 36
ineffective at treating the psychiatric condition. 37
(b) A drug that is an alternative to an opioid, if the provider of 38
health care who prescribes or administers such a drug to a 39
recipient of Medicaid confi rms that, in the professional judgment 40
of the provider of health care, the drug is appropriate for the 41
treatment of the recipient. 42
4. The Department shall not require the Drug Use Review 43
Board to develop, review or approve prior authorization policies or 44

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procedures necessary for the operation of the list of preferr ed 1
prescription drugs developed pursuant to NRS 422.4025. 2
5. The Department shall accept recommendations from the 3
Drug Use Review Board as the basis for developing or revising step 4
therapy protocols and prior authorization policies and procedures 5
used by the Medicaid program for prescription drugs. 6
6. As used in this section: 7
(a) “Medical or scientific evidence” has the meaning ascribed to 8
it in NRS 695G.053. 9
(b) “Provider of health care” has the meaning ascribed to it in 10
NRS 629.031. 11
(c) “Step therapy protocol” means a procedure that requires a 12
recipient of Medicaid to use a prescription drug or sequence of 13
prescription drugs other than a drug that a practitioner recommends 14
for trea tment of a [psychiatric] condition of the recipient before 15
Medicaid provides coverage for the recommended drug. 16
Sec. 17. The provisions of NRS 354.599 do not apply to any 17
additional expenses of a local government that are related to the 18
provisions of this act. 19
Sec. 18. 1. This section becomes effective upon passage and 20
approval. 21
2. Sections 1 to 17, inclusive, of this act become effective: 22
(a) Upon passage and approval for the purpose of adopting any 23
regulations and performing any other prep aratory administrative 24
tasks that are necessary to carry out the provisions of this act; and 25
(b) On January 1, 2026, for all other purposes. 26

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