2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.4025 - List of preferred prescription drugs used for Medicaid program and Children’s Health Insurance Program; list of drugs excluded from restrictions; role of Pharmacy and Therapeutics Committee; availability of new pharmaceutical products and products for which there is new evidence report; coverage of certain drugs not on list of preferred prescription drugs; regulations.

1. The Department shall:
(a) By regulation, develop a list of preferred prescription drugs to be used for the Medicaid program and the Children’s Health Insurance Program, and each public or nonprofit health benefit plan that elects to use the list of preferred prescription drugs as its formulary pursuant to NRS 287.012, 287.0433 or 687B.407; and
(b) Negotiate and enter into agreements to purchase the drugs included on the list of preferred prescription drugs on behalf of the health benefit plans described in paragraph (a) or enter into a contract pursuant to NRS 422.4053 with a pharmacy benefit manager, health maintenance organization or one or more public or private entities in this State, the District of Columbia or other states or territories of the United States, as appropriate, to negotiate such agreements.
2. The Department shall, by regulation, establish a list of prescription drugs which must be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs established pursuant to subsection 1. The list established pursuant to this subsection must include, without limitation:
(a) Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus, including, without limitation, antiretroviral medications;
(b) Antirejection medications for organ transplants;
(c) Antihemophilic medications; and
(d) Any prescription drug which the Board identifies as appropriate for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs.
3. The regulations must provide that the Board makes the final determination of:
(a) Whether a class of therapeutic prescription drugs is included on the list of preferred prescription drugs and is excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;
(b) Which therapeutically equivalent prescription drugs will be reviewed for inclusion on the list of preferred prescription drugs and for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs; and
(c) Which prescription drugs should be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.
4. The list of preferred prescription drugs established pursuant to subsection 1 must include, without limitation:
(a) Any prescription drug determined by the Board to be essential for treating sickle cell disease and its variants; and
(b) Prescription drugs to prevent the acquisition of human immunodeficiency virus.
5. The regulations must provide that each new pharmaceutical product and each existing pharmaceutical product for which there is new clinical evidence supporting its inclusion on the list of preferred prescription drugs must be made available pursuant to the Medicaid program with prior authorization until the Board reviews the product or the evidence.
6. The Medicaid program must cover a prescription drug that is not included on the list of preferred prescription drugs as if the drug were included on that list if:
(a) The drug is:
(1) Used to treat hepatitis C;
(2) Used to provide medication-assisted treatment for opioid use disorder;
(3) Used to support safe withdrawal from substance use disorder; or
(4) In the same class as a drug on the list of preferred prescription drugs; and
(b) All preferred prescription drugs within the same class as the drug are unsuitable for a recipient of Medicaid because:
(1) The recipient is allergic to all preferred prescription drugs within the same class as the drug;
(2) All preferred prescription drugs within the same class as the drug are contraindicated for the recipient or are likely to interact in a harmful manner with another drug that the recipient is taking;
(3) The recipient has a history of adverse reactions to all preferred prescription drugs within the same class as the drug; or
(4) The drug has a unique indication that is supported by peer-reviewed clinical evidence or approved by the United States Food and Drug Administration.
7. The Medicaid program must automatically cover any typical or atypical antipsychotic medication or anticonvulsant medication that is not on the list of preferred prescription drugs upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid.
8. On or before February 1 of each year, the Department shall:
(a) Compile a report concerning the agreements negotiated pursuant to paragraph (b) of subsection 1 and contracts entered into pursuant to NRS 422.4053 which must include, without limitation, the financial effects of obtaining prescription drugs through those agreements and contracts, in total and aggregated separately for agreements negotiated by the Department, contracts with a pharmacy benefit manager, contracts with a health maintenance organization and contracts with public and private entities from this State, the District of Columbia and other states and territories of the United States; and
(b) Post the report on an Internet website maintained by the Department and submit the report to the Director of the Legislative Counsel Bureau for transmittal to:
(1) In odd-numbered years, the Legislature; or
(2) In even-numbered years, the Legislative Commission.
(Added to NRS by 2003, 1317; A 2010, 26th Special Session, 36; 2011, 985; 2015, 2158; 2017, 2174; 2019, 2167, 4028; 2021, 1751, 3196, 3205; 2023, 522, 3498)