1. Except as otherwise provided in this section, a contract for hospital or medical services which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:
(a) Had previously been approved for coverage by the insurer for a medical condition of an insured and the insured’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured; and
(b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the insured.
2. The provisions of subsection 1 do not:
(a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;
(b) Prohibit:
(1) The insurer from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the insured or from establishing, by contract, limitations on the maximum coverage for prescription drugs;
(2) A provider of health care from prescribing another drug covered by the contract that is medically appropriate for the insured; or
(3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or
(c) Require any coverage for a drug after the term of the contract.
3. Any provision of a contract for hospital or medical services subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.
(Added to NRS by 2001, 862; A 2003, 2300; 2017, 638)
Structure Nevada Revised Statutes
Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service
NRS 695B.040 - Corporations authorized to undertake and operate plans.
NRS 695B.050 - Manner of incorporation.
NRS 695B.060 - Directors: Qualifications.
NRS 695B.070 - Merger and consolidation: Procedure.
NRS 695B.080 - Merger and consolidation: Continuance of contracts and contribution certificates.
NRS 695B.090 - Merger and consolidation: Withdrawal of prior deposit of securities.
NRS 695B.110 - Certificate of authority: Required; fees.
NRS 695B.120 - Certificate of authority: Qualifications.
NRS 695B.130 - Certificate of authority: Application; issuance.
NRS 695B.135 - Certificate of authority: Expiration; renewal.
NRS 695B.165 - Annual statement required to include report of net worth.
NRS 695B.170 - Acquisition costs and administrative expenses; effect of finding of excess costs.
NRS 695B.180 - Required provisions.
NRS 695B.189 - Group contract: Required provision permitting continuation of coverage.
NRS 695B.190 - Family contracts.
NRS 695B.1951 - Reimbursement for treatment by podiatrist.
NRS 695B.1955 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.
NRS 695B.196 - Reimbursement for acupuncture.
NRS 695B.197 - Reimbursement for treatment by licensed psychologist.
NRS 695B.199 - Reimbursement for services provided by certain nurses.
NRS 695B.1995 - Reimbursement to provider of medical transportation.
NRS 695B.200 - Group contracts written under master contract: Conditions required for issuance.
NRS 695B.210 - Group master service contract: Required provisions.
NRS 695B.225 - Policies of group insurance: Order of benefits.
NRS 695B.230 - Filing and approval of forms and schedules of premium rates.
NRS 695B.240 - Provision of group service coverage before approval of forms.
NRS 695B.250 - Extensions of time; automatic approval.
NRS 695B.252 - Conversion privilege available to spouse and children; conditions.
NRS 695B.254 - Choice of types of contracts required to be offered.
NRS 695B.256 - Issuance and effective date of converted contract; premiums; persons covered.
NRS 695B.257 - Notice of conversion privilege.
NRS 695B.2575 - Converted contract delivered outside Nevada: Form.
NRS 695B.258 - Extension of coverage under existing group contract.
NRS 695B.2585 - Provision of group coverage in lieu of converted individual contract.
NRS 695B.259 - Continuation of identical coverage in lieu of converted contract.
NRS 695B.260 - Suspension or revocation of permission to provide coverage before approval of forms.
NRS 695B.270 - Disapproval of forms; issuance unlawful.
NRS 695B.280 - Regulations; limitations.
NRS 695B.285 - Use of Uniform Billing and Claims Forms authorized.
NRS 695B.290 - Agent’s license required.
NRS 695B.320 - Applicability of other provisions.
NRS 695B.380 - Establishment; approval; requirements; examination.