NRS 689C.168
Coverage for prescription drug previously approved for medical condition of insured.

1.

Except as otherwise provided in this section, a health benefit plan which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:

(a)

Had previously been approved for coverage by the carrier for a medical condition of an insured and the insured’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured; and

(b)

Is appropriately prescribed and considered safe and effective for treating the medical condition of the insured.

2.

The provisions of subsection 1 do not:

(a)

Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;

(b)

Prohibit:

(1)

The carrier from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the insured or from establishing, by contract, limitations on the maximum coverage for prescription drugs;

(2)

A provider of health care from prescribing another drug covered by the plan that is medically appropriate for the insured; or

(3)

The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or

(c)

Require any coverage for a drug after the term of the plan.

3.

Any provision of a health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.

Source: Section 689C.168 — Coverage for prescription drug previously approved for medical condition of insured., https://www.­leg.­state.­nv.­us/NRS/NRS-689C.­html#NRS689CSec168 (accessed May 26, 2025).

689C.015
Definitions. 689C.017
“Affiliated” defined. 689C.019
“Affiliation period” defined. 689C.023
“Bona fide association” defined. 689C.025
“Carrier” defined. 689C.045
“Class of business” defined. 689C.047
“Control” defined. 689C.053
“Creditable coverage” defined. 689C.055
“Dependent” defined. 689C.065
“Eligible employee” defined. 689C.066
“Employee leasing company” defined. 689C.071
“Geographic rating area” defined. 689C.072
“Geographic service area” defined. 689C.073
“Group health plan” defined. 689C.075
“Health benefit plan” defined. 689C.077
“Network plan” defined. 689C.078
“Open enrollment” defined. 689C.079
“Plan for coverage of a bona fide association” defined. 689C.081
“Plan sponsor” defined. 689C.082
“Preexisting condition” defined. 689C.083
“Producer” defined. 689C.085
“Rating period” defined. 689C.095
“Small employer” defined. 689C.106
“Waiting period” defined. 689C.109
Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan 689C.111
Employee leasing company deemed large employer in certain circumstances. 689C.113
Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer. 689C.115
Mandatory and optional coverage. 689C.125
Rating factors for determining premiums. 689C.135
Effect of provision in health benefit plan for restricted network on determination of rates. 689C.143
Offering of policy of health insurance for purposes of establishing health savings account. 689C.155
Regulations. 689C.156
Each health benefit plan marketed in this State required to be offered to small employers. 689C.158
Producer may only sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or related to bona fide association. 689C.159
Certain provisions inapplicable to plan that carrier makes available only through bona fide association. 689C.160
Carrier must uniformly apply requirements to determine whether to provide coverage. 689C.165
Carrier prohibited from modifying plan to restrict or exclude coverage for certain services. 689C.166
Coverage for alcohol or substance use disorder: Required. 689C.167
Coverage for alcohol or substance use disorders: Benefits. 689C.168
Coverage for prescription drug previously approved for medical condition of insured. 689C.169
Coverage for severe mental illness. 689C.170
Authorized variation of minimum participation and contributions 689C.180
Carrier to offer same coverage to all eligible employees 689C.183
Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances. 689C.187
Manner and period for enrolling dependent of covered employee 689C.190
Requirements regarding issuance of health benefit plans and adjustment of costs. 689C.191
Determination of applicable creditable coverage of person 689C.192
Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person. 689C.193
Carrier prohibited from imposing restriction on participation inconsistent with certain sections 689C.194
Plan that includes coverage for maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth 689C.195
Coverage for services provided through telehealth. 689C.196
Insurer prohibited from denying coverage solely because person was victim of domestic violence. 689C.197
Carrier prohibited from denying coverage because insured was intoxicated or under influence of controlled substance 689C.198
Insurer prohibited from requiring or using information concerning genetic testing 689C.200
When carrier is not required to offer coverage. 689C.203
Denial of application for coverage from small employer 689C.207
Regulations concerning reissuance of health benefit plan. 689C.220
Adjustment in rates to be applied uniformly. 689C.265
Carrier authorized to modify coverage for insurance product under certain circumstances. 689C.270
Regulations concerning disclosures by carrier to small employer 689C.280
Carrier to provide required disclosures to small employer before issuing policy of insurance. 689C.281
Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 689C.310
Renewal of health benefit plan 689C.320
Required notification when carrier discontinues transacting insurance in this State 689C.325
Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees. 689C.330
When insurer is required to allow employee to continue coverage after employee is no longer covered by health benefit plan. 689C.350
Health benefit plan with preferred providers of health care: Deductible 689C.355
Prohibited acts of carrier or producer 689C.1065
Applicability. 689C.1565
Coverage to small employers not required under certain circumstances 689C.1655
Coverage for autism spectrum disorders. 689C.1672
Coverage for certain tests and vaccines relating to human papillomavirus 689C.1674
Coverage for mammograms for certain women 689C.1676
Coverage for drug or device for contraception and related health services 689C.1678
Coverage for certain services, screenings and tests relating to wellness 689C.1683
Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications. 689C.1685
Coverage for early refills of topical ophthalmic products. 689C.1687
Coverage for management and treatment of sickle cell disease. 689C.1945
Plan that includes coverage for maternity care must not deny coverage to gestational carrier

May 26, 2025

§ 689C.168. Coverage for prescription drug previously approved for medical condition of insured.'s source at nv​.us