1. A managed care organization that offers or issues a health care plan which provides coverage for prescription drugs:
(a) Must authorize coverage for and may apply a copayment and deductible to a prescription that is dispensed by a pharmacy for less than a 30-day supply if, for the purpose of synchronizing the insured’s chronic medications:
(1) The prescriber or pharmacist determines that filling or refilling the prescription in that manner is in the best interest of the insured; and
(2) The insured requests less than a 30-day supply.
(b) May not deny coverage for a prescription described in paragraph (a) which is otherwise approved for coverage by the managed care organization.
(c) Unless otherwise provided by a contract or other agreement, may not prorate any pharmacy dispensing fees for a prescription described in paragraph (a).
2. An evidence of coverage subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2017, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the evidence of coverage or renewal which is in conflict with this section is void.
3. The provisions of this section do not apply to unit-of-use packaging for which synchronization is not practicable or to a controlled substance.
4. As used in this section:
(a) "Chronic medication" means any drug that is prescribed to treat any disease or other condition which is determined to be permanent, persistent or lasting indefinitely.
(b) "Synchronization" means the alignment of the dispensing of multiple medications by a single contracted pharmacy for the purpose of improving a patient’s adherence to a prescribed course of medication.
(c) "Unit-of-use packaging" means medication that is prepackaged by the manufacturer in blister packs, compliance packs, course-of-therapy packs or any other packaging which is designed and intended to be dispensed directly to the patient without modification by the dispensing pharmacy, except for the addition of a prescription label.
(Added to NRS by 2015, 2129)
Structure Nevada Revised Statutes
NRS 695G.012 - "Adverse determination" defined.
NRS 695G.014 - "Authorized representative" defined.
NRS 695G.015 - "Benefits" defined.
NRS 695G.016 - "Clinical peer" defined.
NRS 695G.017 - "Covered person" defined.
NRS 695G.019 - "Health benefit plan" defined.
NRS 695G.020 - "Health care plan" defined.
NRS 695G.022 - "Health care services" defined.
NRS 695G.024 - "Health carrier" defined.
NRS 695G.026 - "Independent review organization" defined.
NRS 695G.030 - "Insured" defined.
NRS 695G.040 - "Managed care" defined.
NRS 695G.050 - "Managed care organization" defined.
NRS 695G.053 - "Medical or scientific evidence" defined.
NRS 695G.055 - "Medically necessary" defined.
NRS 695G.060 - "Primary care physician" defined.
NRS 695G.070 - "Provider of health care" defined.
NRS 695G.080 - "Utilization review" defined.
NRS 695G.085 - "Utilization review organization" defined.
NRS 695G.090 - Applicability of chapter and other provisions.
NRS 695G.100 - Documents filed with Commissioner treated as public record; exception.
NRS 695G.110 - Medical director required to be physician licensed in this State.
NRS 695G.125 - Contracts with certain federally qualified health centers.
NRS 695G.140 - Certain persons in managed care organization in fiduciary relationship to insured.
NRS 695G.150 - Authorization of recommended and covered health care services required.
NRS 695G.190 - Quality improvement committee: Administration; duties.
NRS 695G.210 - Review board; appeal; right to expedited review of complaint; notice to insured.
NRS 695G.245 - Written notice of right to request external review; form; contents.
NRS 695G.247 - Requests for external review to be in writing; exception; form and content.
NRS 695G.271 - Expedited approval or denial of request.
NRS 695G.280 - Basis for decision of independent review organization.
NRS 695G.300 - Submission of complaint of covered person to independent review organization.