Healthcare (Prescription Drugs)

AB 259 requires pharmacies, insurers, and healthcare providers in Nevada to pay or reimburse no more than the federal "maximum fair price" for certain prescription drugs covered under Medicare. It directly affects drug purchasers and reimbursers within Nevada who handle federally negotiated drugs, while exempting certain federal health coverage providers (like those under ERISA) unless they voluntarily opt-in. The bill makes overpayment a "deceptive trade practice" under Nevada law, enabling civil lawsuits by affected parties but removing criminal penalties. The bill passed the Nevada legislature in June 2025 but was vetoed by the Governor on June 12, 2025.

SB 149 creates a single "state pharmacy benefit manager" (SPBM) to administer all Medicaid prescription drug coverage in Nevada, replacing the current system where multiple pharmacy benefit managers (PBMs) or health plans manage these benefits separately. It requires the Department of Health and Human Services to contract exclusively with one SPBM, mandates Medicaid managed care organizations to use this SPBM for all pharmacy benefits, and sets strict rules for SPBM contracts, including prohibitions on conflicts of interest and requirements for fair reimbursement to pharmacies. The bill also establishes detailed application standards for potential SPBMs, including disclosures about ownership ties to pharmacies or health insurers, and mandates non-discriminatory reimbursement rates for all pharmacies, including those owned by healthcare facilities. These changes aim to streamline administration, ensure consistent pharmacy payments, and align with federal Medicaid requirements.

SB 389 requires Nevada's Department of Health and Human Services to select a single state pharmacy benefit manager (SPBM) by January 1, 2030, to manage prescription drug coverage for Medicaid, the Children’s Health Insurance Program (CHIP), and other health plans using Medicaid’s formulary. The bill mandates reimbursement rates based on the "Nevada Average Acquisition Cost" (NAAC), which uses actual drug acquisition costs to maximize state savings, and requires Medicaid managed care organizations to contract with the SPBM and disclose pharmacy spending data. It also sets strict criteria for SPBM selection, prohibits conflicts of interest, and requires Department approval for all pharmacy contracts under the SPBM.

SB 209 updates Nevada's rules for pharmacy benefit managers (PBMs), entities that manage prescription drug coverage for insurers. It expands the definition of "pharmacy benefits plan" to include pharmacist services, requiring PBMs to disclose all fees and rebates to insurers and mandating that rebates be used solely to lower premiums or reduce patient costs. The bill prohibits PBMs from steering patients to affiliated pharmacies, discriminating against nonaffiliated pharmacies, or using deceptive pricing practices. These changes apply to PBMs managing coverage for insurers, Medicaid, and employer plans, with new annual reporting requirements for transparency.

SB 354 prohibits health insurance plans (including Medicaid and government employee plans) from requiring step therapy - where patients must try cheaper drugs first - before covering medications that prevent or treat HIV or hepatitis C. It applies directly to insurers offering health coverage and affects patients needing these specific treatments. The bill removes an existing exception allowing step therapy for these drugs, mandating direct coverage for HIV prevention/treatment medications and related lab tests without prior authorization. This changes how insurers must cover these essential medications, ensuring faster access without unnecessary barriers.

AB 555 caps out-of-pocket costs for prescription insulin under private health insurance policies at $35 for a 30-day supply, directly affecting insured individuals with diabetes (including type I, II, and gestational diabetes). It prohibits insurers from charging more than this amount regardless of the specific insulin drug prescribed, while requiring coverage to align with standard policy terms for other treatments. The bill excludes coverage for Medicaid/CHIP recipients and government employees (including their dependents), and allows the Insurance Commissioner to penalize non-compliant insurers. This policy change takes effect immediately without additional state or local costs.

SB 316 regulates pharmacy benefit managers (PBMs), the companies that manage prescription drug coverage for insurers. It prohibits PBMs from steering patients to affiliated pharmacies, requiring them to disclose fees and rebates to insurers, and mandating that PBMs pass all rebates to insurers. Insurers must then use these rebate funds exclusively to lower premiums or reduce patient cost-sharing for prescriptions, and cannot charge patients more than the insurer pays for a drug. This directly affects PBMs, health insurers, and patients by increasing transparency and reducing out-of-pocket costs.