1. A prepaid limited health service organization that offers or issues evidence of coverage which provides coverage for prescription drugs shall include with any evidence of that coverage provided to a subscriber, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the organization pursuant to subsection 2. The notice required by this subsection must:
(a) Be in a language that is easily understood and in a format that is easy to understand;
(b) Include an explanation of what a formulary is; and
(c) If a formulary is used, include:
(1) An explanation of:
(I) How often the contents of the formulary are reviewed; and
(II) The procedure and criteria for determining which prescription drugs are included in and excluded from the formulary; and
(2) The telephone number of the organization for making a request for information regarding the formulary pursuant to subsection 2.
2. If a prepaid limited health service organization offers or issues evidence of coverage which provides coverage for prescription drugs and a formulary is used, the organization shall:
(a) Provide to any enrollee or participating provider of health care, upon request:
(1) Information regarding whether a specific drug is included in the formulary.
(2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the organization shall notify the requester that a choice of formulary lists is available.
(b) Notify each person who requests information regarding the formulary, that the inclusion of a drug in the formulary does not guarantee that a provider of health care will prescribe that drug for a particular medical condition.
(Added to NRS by 2001, 864)
Structure Nevada Revised Statutes
Chapter 695F - Prepaid Limited Health Service Organizations
NRS 695F.020 - "Enrollee" defined.
NRS 695F.030 - "Evidence of coverage" defined.
NRS 695F.040 - "Limited health service" defined.
NRS 695F.043 - "Medicaid" defined.
NRS 695F.047 - "Order for medical coverage" defined.
NRS 695F.050 - "Prepaid limited health service organization" defined.
NRS 695F.060 - "Provider" defined.
NRS 695F.070 - "Subscriber" defined.
NRS 695F.080 - General applicability of title 57 of NRS.
NRS 695F.090 - Applicability of chapter and other provisions.
NRS 695F.100 - Certificate required.
NRS 695F.110 - Application; fee.
NRS 695F.120 - Review of application; issuance of certificate.
NRS 695F.140 - Denial of application; hearing.
NRS 695F.150 - Evidence of coverage: Issuance; contents; amendment.
NRS 695F.160 - Rates and charges: Reasonableness.
NRS 695F.190 - Requirements for reserve.
NRS 695F.210 - Maintenance of fidelity bond or deposit in lieu of bond.
NRS 695F.212 - Hazardous financial condition: Regulations; determination; powers of Commissioner.
NRS 695F.230 - Establishment of system for resolution of complaints.
NRS 695F.310 - Examinations and investigations.
NRS 695F.330 - Payment of premium tax.
NRS 695F.360 - Violations of chapter: Order to cease and desist; fine.
NRS 695F.410 - Confidentiality and disclosure of information.