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Nevada Revised Statutes Title 57. Insurance § 687B.4095. Policies of health insurance including prescription drug coverage: Restrictions on moving prescription drug from lower-cost tier to higher-cost tier

Current as of January 01, 2025 | Updated by Findlaw Staff

1. If a policy of health insurance issued to an individual pursuant to chapter 689A, 695B or 695C of NRS includes coverage for a prescription drug pursuant to a formulary with more than one cost tier, the insurer may move the prescription drug from a lower cost tier to a higher cost tier only:

(a) On January 1; and

(b) On any date on which the insurer adds to the formulary a generic prescription drug that:

(1) Has been approved by the Food and Drug Administration for use as an alternative to the original prescription drug; and

(2) Is being added to the formulary at:

(I) The same cost tier from which the original prescription drug is being moved; or

(II) A cost tier which has a smaller deductible, copayment or coinsurance than the cost tier from which the original prescription drug is being moved.

2. If a policy of health insurance issued to a small employer pursuant to chapter 689C, 695B or 695C of NRS includes coverage for a prescription drug pursuant to a formulary with more than one cost tier, the insurer may move the prescription drug from a lower cost tier to a higher cost tier only:

(a) On January 1;

(b) On July 1; and

(c) On any date on which the insurer adds to the formulary a generic prescription drug that:

(1) Has been approved by the Food and Drug Administration for use as an alternative to the original prescription drug; and

(2) Is being added to the formulary at:

(I) The same cost tier from which the original prescription drug is being moved; or

(II) A cost tier which has a smaller deductible, copayment or coinsurance than the cost tier from which the original prescription drug is being moved.

3. An insurer who issues a policy of health insurance described in subsection 1 or 2 and who removes a prescription drug from a formulary shall not, in the same plan year in which the prescription drug was removed, add the prescription drug back to the formulary in a higher cost tier except in accordance with the provisions of subsection 1 or 2, as applicable.

4. Except as otherwise provided in subsection 3, the provisions of this section do not prevent an insurer, at any time, from:

(a) Moving a prescription drug from a higher cost tier of a formulary to a lower cost tier of the formulary;

(b) Removing a prescription drug from a formulary; or

(c) Adding a prescription drug to a formulary.

5. This section does not apply to a grandfathered plan.

6. The provisions of this section must not be construed to limit the conditions under which a pharmacist is otherwise authorized or required by law to substitute:

(a) A generic drug for a drug prescribed by brand name; or

(b) An interchangeable biological product for a biological product prescribed by brand name.

7. As used in this section:

(a) “Biological product” has the meaning ascribed to it in NRS 639.0017.

(b) “Individual carrier” has the meaning ascribed to it in NRS 689A.550.

(c) “Insurer” includes, without limitation:

(1) An individual carrier; and

(2) A governmental entity which offers, administers or otherwise provides a policy of health insurance.

(d) “Interchangeable biological product” has the meaning ascribed to it in NRS 639.00855.

(e) “Small employer” has the meaning ascribed to it in NRS 689C.095.

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Cite this article: FindLaw.com - Nevada Revised Statutes Title 57. Insurance § 687B.4095. Policies of health insurance including prescription drug coverage: Restrictions on moving prescription drug from lower-cost tier to higher-cost tier - last updated January 01, 2025 | https://codes.findlaw.com/nv/title-57-insurance/nv-rev-st-687b-4095/

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