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: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: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.4.
This section does not apply to a grandfathered plan.5.
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.6.
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.
Source:
Section 687B.4095 — Policies of health insurance including prescription drug coverage: Restrictions on moving prescription drug from lower-cost tier to higher-cost tier., https://www.leg.state.nv.us/NRS/NRS-687B.html#NRS687BSec4095.