Current through February 27, 2024
1. Except as
otherwise provided in this section, an individual carrier that offers a health
benefit plan which provides coverage for prescription drugs and uses a
formulary that has been approved by the Commissioner pursuant to
NRS
687B.120 shall not:
(a) Remove a prescription drug from the
formulary; or
(b) If the formulary
includes two or more tiers of benefits providing for different deductibles,
copayments or coinsurance applicable to the prescription drugs in each tier,
move a drug to a tier with a larger deductible, copayment or coinsurance,
during the plan year for which the formulary was approved by the
Commissioner.
2. An
individual carrier described in subsection 1 may:
(a) Remove a prescription drug from a
formulary at any time if:
(1) The drug is not
approved by the United States Food and Drug Administration;
(2) The United States Food and Drug
Administration issues a notice, guidance, warning, announcement or any other
statement about the drug which calls into question the clinical safety of the
drug; or
(3) The prescription drug
is approved by the United States Food and Drug Administration for use without a
prescription.
(b) If the
individual carrier's formulary includes two or more tiers of benefits providing
for different deductibles, copayments or coinsurance applicable to the
prescription drugs in each tier, move a brand name prescription drug to a tier
with a larger deductible, copayment or coinsurance if the individual carrier
adds to the formulary a generic prescription drug that is approved by the
United States Food and Drug Administration for use as an alternative to the
brand name prescription drug at:
(1) The
benefit tier from which the brand name prescription drug is being moved; or
(2) A benefit tier that has a
smaller deductible, copayment or coinsurance than the benefit tier from which
the brand name prescription drug is being moved.
3. This section does not prohibit an
individual carrier from adding a prescription drug to a formulary at any time.
4. This section does not apply to
a grandfathered plan.
5. As used
in this section:
(a) "Health benefit plan"
has the meaning ascribed to it in
NRS
687B.470.
(b) "Individual carrier" has the meaning
ascribed to it in
NRS
689A.550.
Added to
NAC by Comm'r of Insurance by
R074-14,
eff. 1/1/2016
NRS
679B.130,
687B.120,
689A.710
