NRS 422.4053
Department to manage payments and rebates for prescription drugs

  • contract for provision of certain services.

1.

Except as otherwise provided in subsection 2, the Department shall directly manage, direct and coordinate all payments and rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program.

2.

The Department may enter into a contract with:

(a)

A pharmacy benefit manager for the provision of any services described in subsection 1.

(b)

A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 for recipients of Medicaid or recipients of insurance through the Children’s Health Insurance Program who receive coverage through a Medicaid managed care program.

3.

A contract entered into pursuant to subsection 2 must:

(a)

Include the provisions required by NRS 422.4056; and

(b)

Require the pharmacy benefit manager or health maintenance organization, as applicable, to disclose to the Department any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid and any fees and charges imposed by the pharmacy benefit manager or health maintenance organization pursuant to the contract.

4.

In addition to meeting the requirements of subsection 3, a contract entered into pursuant to:

(a)

Paragraph (a) of subsection 2 may require the pharmacy benefit manager to provide the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, to the Department.

(b)

Paragraph (b) of subsection 2 must require the health maintenance organization to provide to the Department the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, less an administrative fee in an amount prescribed by the contract. The Department shall adopt policies prescribing the maximum amount of such an administrative fee.

Source: Section 422.4053 — Department to manage payments and rebates for prescription drugs; contract for provision of certain services., https://www.­leg.­state.­nv.­us/NRS/NRS-422.­html#NRS422Sec4053 (accessed May 26, 2025).

422.001
Definitions. 422.003
“Administrator” defined. 422.021
“Children’s Health Insurance Program” defined. 422.030
“Department” defined. 422.040
“Director” defined. 422.041
“Division” defined. 422.046
“Medicaid” defined. 422.050
“Public assistance” defined. 422.054
“Undivided estate” defined. 422.061
Purposes of Division. 422.063
State plans for certain programs: Development, adoption and revision by Director 422.064
State plans for certain programs: Priority access to treatment and services for certain parents. 422.065
Eligibility of persons who are not citizens or nationals of United States for state or local public benefits. 422.075
Division to submit certain information to Nevada Commission on Autism Spectrum Disorders. 422.151
Creation 422.153
Composition 422.155
Chair 422.162
Creation 422.165
Duties. 422.240
Legislative appropriations 422.242
Gifts and grants of money to Division: Deposit in Gift and Cooperative Account of the Division of Health Care Financing and Policy 422.260
Acceptance of Social Security Act and federal money. 422.265
Acceptance of increased benefits of future congressional legislation 422.267
Contract or agreement with Federal Government by Director. 422.270
Duties of Department regarding Medicaid and Children’s Health Insurance Program. 422.272
State Plan for Medicaid: Inclusion of requirement for payment of certain costs. 422.273
Establishment, development and implementation of Medicaid managed care program. 422.275
Legal advisers for Division. 422.276
Appeal to Division by applicant for or recipient of benefits from Medicaid or Children’s Health Insurance Program 422.277
Hearing: Rights of parties 422.278
Hearing: Person with communications disability entitled to services of interpreter. 422.279
Judicial review: Taking of additional evidence 422.280
Forms of reports and records to be kept by persons subject to supervision or investigation by Division. 422.291
Assistance not assignable or subject to process or bankruptcy law. 422.292
Assistance subject to future amending and repealing acts. 422.293
Subrogation: Department subrogated to rights of recipient of Medicaid or of insurance provided pursuant to Children’s Health Insurance Program 422.305
Confidentiality of information obtained in investigation of provider of services under State Plan for Medicaid. 422.306
Hearing to review action taken against provider of services under State Plan for Medicaid 422.308
Family planning service 422.309
Provision of prenatal care to pregnant women who are indigent 422.361
Definitions. 422.362
“Cardholder” defined. 422.363
“Medicaid card” defined. 422.364
“Plan” defined. 422.365
“Receives” defined. 422.366
Unlawful acts: Obtaining or possessing card without consent of holder of card 422.367
Unlawful acts: Sale or purchase of card 422.368
Unlawful acts: Use of forged, expired or revoked card to obtain benefits 422.369
Unlawful acts: Fraud by person authorized to provide care to holder of card 422.376
“Facility for intermediate care” defined. 422.378
Report by nursing facility to Division. 422.379
Administrative penalties for late payment of fee 422.380
Definitions. 422.382
Intergovernmental transfers of money from counties to Division 422.385
Disproportionate share payments from Medicaid Budget Account 422.387
Calculation of disproportionate share payments 422.390
Regulations 422.396
Establishment and administration of program to provide community-based services 422.401
Definitions. 422.402
“Drug Use Review Board” defined. 422.403
Establishment and management of use by Medicaid program of step therapy and prior authorization 422.404
Silver State Scripts Board: Chair 422.405
Silver State Scripts Board: Duties and powers. 422.406
Regulations 422.410
Fraudulent acts 422.450
Definitions. 422.460
“Benefit” defined. 422.470
“Claim” defined. 422.480
“Plan” defined. 422.490
“Provider” defined. 422.500
“Recipient” defined. 422.510
“Records” defined. 422.520
“Sign” defined. 422.525
“Statement or representation” defined. 422.530
Responsibility for false claim, statement or representation. 422.540
Offenses regarding false claims, statements or representations 422.550
Statement regarding truth and accuracy of applications, reports and invoices 422.560
Offenses regarding sale, purchase or lease of goods, services, materials or supplies 422.570
Intentional failure to maintain adequate records 422.580
Civil penalties for certain violations 422.590
Limitation and accrual of actions. 422.2354
Qualifications. 422.2356
Executive Officer of Division 422.2357
Administration of chapter. 422.2358
Reports. 422.2362
Fiscal duties. 422.2364
Organization of Division 422.2366
Administration of oaths 422.2368
Adoption of regulations. 422.2369
Procedure for adopting, amending or repealing regulations. 422.2372
General and miscellaneous powers and duties. 422.2374
Cooperation with Medicaid Fraud Control Unit 422.2703
Department required to establish and maintain system for electronic submission of applications for Medicaid or Children’s Health Insurance Program. 422.2704
Review of rates of reimbursement. 422.2712
Reporting of certain rates of reimbursement for physicians. 422.2717
State Plan for Medicaid: Inclusion of requirement that independent foster care adolescents are eligible for Medicaid. 422.2718
State Plan for Medicaid: Inclusion of requirement for payment of certain expenses related to testing for human papillomavirus and administration of human papillomavirus vaccine. 422.2719
State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to fetal alcohol spectrum disorders. 422.2721
State Plan for Medicaid: Payment for services provided through telehealth. 422.2723
State Plan for Medicaid: Inclusion of requirement for payment of certain costs relating to dialysis and emergency care to treat kidney failure. 422.2724
State Plan for Medicaid: Reimbursement of registered nurse for certain services provided to persons eligible for Medicaid. 422.2735
Program to provide increased capitation payments to Medicaid managed care plans for ground emergency medical transportation services provided by governmental provider. 422.2748
Cooperation with Medicaid Fraud Control Unit. 422.2749
Custody, use, preservation and confidentiality of records, files and communications concerning applicants for and recipients of public assistance or assistance pursuant to Children’s Health Insurance Program. 422.2775
Hearing: Evidence. 422.2785
Contents and delivery of decision or order of hearing officer 422.3085
Development of Sexual Trauma Services Guide 422.3755
Definitions. 422.3765
“Facility for skilled nursing” defined. 422.3771
“Nursing facility” defined. 422.3775
Payment of fee 422.3785
Creation of Account to Increase the Quality of Nursing Care 422.3791
Definitions. 422.3792
“Agency to provide personal care services in the home” defined. 422.3793
“Operator” defined. 422.3794
Imposition of assessment 422.3795
Administrative penalties 422.3805
Federal waivers: Duties of Administrator. 422.3962
Amendment of home and community-based services waiver to include as medical assistance under Medicaid funding of assisted living supportive services for senior citizens who reside in certain assisted living facilities. 422.3964
State Plan for Medicaid: Inclusion of certain home and community-based services. 422.4015
“Board” defined. 422.4021
“Health benefit plan” defined. 422.4022
“Health maintenance organization” defined. 422.4023
“Pharmacy benefit manager” defined. 422.4024
“Sickle cell disease and its variants” defined. 422.4025
List of preferred prescription drugs used for Medicaid program and Children’s Health Insurance Program 422.4026
Coverage of certain supplements for treating sickle cell disease and its variants. 422.4035
Silver State Scripts Board: Creation 422.4045
Silver State Scripts Board: Members serve without compensation 422.4053
Department to manage payments and rebates for prescription drugs 422.4056
Audits of certain contracts. 422.27172
State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to family planning. 422.27174
State Plan for Medicaid: Inclusion of requirement for payment of certain costs for preventative care. 422.27176
State Plan for Medicaid: Inclusion of requirement for payment of certain costs for mammogram. 422.27178
State Plan for Medicaid: Inclusion of requirement for payment of certain costs for breastfeeding supplies and prenatal screenings and tests. 422.27234
State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to sickle cell disease and its variants. 422.27238
State Plan for Medicaid: Reimbursement for crisis stabilization services. 422.27239
State Plan for Medicaid: Reimbursement for services of psychological assistant, psychological intern or psychological trainee. 422.27241
State Plan for Medicaid: Reimbursement for services for hospice care provided to persons eligible for Medicaid. 422.27242
State Plan for Medicaid and Children’s Health Insurance Program: Inclusion of authorization for enrollment of certain children. 422.27243
Program to provide medical assistance to certain persons who are employed and have disabilities. 422.27247
Application for federal waiver to provide certain dental care for certain persons. 422.27482
Report concerning provision of health benefits by large employers. 422.27485
Enrollment of eligible Indian children in Children’s Health Insurance Program: Duty of Department to seek assistance of and cooperate with Indian tribes 422.27495
Contracts for provision of certain transportation services for recipients of Medicaid and recipients of services pursuant to Children’s Health Insurance Program. 422.29301
Administration of provisions concerning recovery of amounts incorrectly paid for recipient of Medicaid. 422.29302
Recovery of benefits paid for Medicaid: Powers and duties of Department 422.29304
Recovery of amounts paid for Medicaid under certain circumstances 422.29306
Imposition and release of lien on property of recipient of Medicaid. 422.37915
“Account” defined. 422.37925
“Medical facility” defined. 422.37935
“Operator group” defined. 422.37945
Creation of Account 422.293001
Subrogation: Notice to Department of recipient’s claim 422.293003
Subrogation: Department required to provide notice of amount of lien 422.293005
Subrogation: Liability for failure to comply with provisions.

May 26, 2025

§ 422.4053. Dept. to manage payments & rebates for prescription drugs's source at nv​.us