2023 Nevada Revised Statutes › Chapter 687B - Contracts of Insurance › NRS 687B.4095 - Policies of health insurance including prescription drug coverage: Restrictions on moving prescription drug from lower-cost tier to higher-cost tier.

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.
(Added to NRS by 2017, 1507; A 2023, 2635)