NRS 689A.405
Coverage for prescription drugs: Provision of notice and information regarding use of formulary.


1.

An insurer that offers or issues a policy of health insurance which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the insurer pursuant to subsection 2. The notice required by this subsection must:

(a)

Be in a language that is easily understood and in a format that is easy to understand;

(b)

Include an explanation of what a formulary is; and

(c)

If a formulary is used, include:

(1)

An explanation of:
(I) How often the contents of the formulary are reviewed; and
(II) The procedure and criteria for determining which prescription drugs are included in and excluded from the formulary; and

(2)

The telephone number of the insurer for making a request for information regarding the formulary pursuant to subsection 2.

2.

If an insurer offers or issues a policy of health insurance which provides coverage for prescription drugs and a formulary is used, the insurer shall:

(a)

Provide to any insured or participating provider of health care, upon request:

(1)

Information regarding whether a specific drug is included in the formulary.

(2)

Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the insurer shall notify the requester that a choice of formulary lists is available.

(b)

Notify each person who requests information regarding the formulary, that the inclusion of a drug in the formulary does not guarantee that a provider of health care will prescribe that drug for a particular medical condition.

(c)

During each period for open enrollment, publish on an Internet website that is operated by the insurer and accessible to the public or include in any enrollment materials distributed by the insurer a notice of all prescription drugs that:

(1)

Are included on the most recent list of drugs that are essential for treating asthma and diabetes in this State compiled by the Department of Health and Human Services pursuant to subsection 1 of NRS 439B.630; and

(2)

Have been removed or will be removed from the formulary during the current plan year or the next plan year.

(d)

Update the notice required by paragraph (c) throughout the period for open enrollment.

Source: Section 689A.405 — Coverage for prescription drugs: Provision of notice and information regarding use of formulary., https://www.­leg.­state.­nv.­us/NRS/NRS-689A.­html#NRS689ASec405.

689A.050
Entire contract
689A.060
Time limit on certain defenses.
689A.070
Grace period.
689A.075
Cancellation and rescission of short-term limited duration medical plan.
689A.080
Reinstatement.
689A.090
Notice of claim.
689A.100
Claim forms: Required provision.
689A.105
Claim forms: Uniform billing, claims forms.
689A.110
Claim forms: Acceptance of uniform forms.
689A.120
Time of payment of claims.
689A.130
Payment of claims.
689A.135
Assignment of benefits to provider of health care.
689A.140
Physical examination and autopsy.
689A.150
Legal actions.
689A.160
Change of beneficiary.
689A.170
Right to examine and return policy.
689A.180
Optional provisions.
689A.190
Extended disability benefit.
689A.200
Change of occupation.
689A.210
Misstatement of age.
689A.220
Coordination of benefits: Same insurer.
689A.230
Coordination of benefits: All coverages.
689A.240
Relation of earnings to insurance.
689A.250
Unpaid premiums.
689A.260
Conformity with state statutes.
689A.270
Illegal occupation.
689A.290
Renewability.
689A.300
Order of certain provisions.
689A.310
Ownership of policy by person other than insured.
689A.320
Requirements of other jurisdictions.
689A.330
Policies issued for delivery in another state.
689A.340
Limitation on provisions not subject to chapter
689A.350
Age limit.
689A.380
Definitions of terms used in policies.
689A.390
Summary of coverage: Contents of disclosure
689A.400
Summary of coverage: Copy to be provided before policy issued
689A.405
Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
689A.410
Approval or denial of claims
689A.413
Insurer prohibited from denying coverage solely because person was victim of domestic violence.
689A.415
Insurer prohibited from denying coverage solely because insured was intoxicated or under influence of controlled substance
689A.417
Insurer prohibited from requiring or using information concerning genetic testing
689A.419
Offering policy of health insurance for purposes of establishing health savings account.
Last Updated

Feb. 5, 2021

§ 689A.405’s source at nv​.us