NRS 695A.184
Coverage for prescription drug previously approved for medical condition of insured.

1.

Except as otherwise provided in this section, a benefit contract 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 society 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 society 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 benefit contract 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 benefit contract.

3.

Any provision of a benefit contract 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 695A.184 — Coverage for prescription drug previously approved for medical condition of insured., https://www.­leg.­state.­nv.­us/NRS/NRS-695A.­html#NRS695ASec184.

695A.001
Definitions. 695A.003
“Benefit contract” defined. 695A.004
“Benefit member” defined. 695A.006
“Certificate” defined. 695A.010
“Fraternal benefit society” defined. 695A.014
“Insurer” defined. 695A.016
“Laws” defined. 695A.018
“Lodge” defined. 695A.020
“Lodge system” defined. 695A.023
“Medicaid” defined. 695A.027
“Order for medical coverage” defined. 695A.030
“Premiums” defined. 695A.040
“Representative form of government” defined. 695A.042
“Rules” defined. 695A.044
“Society” defined. 695A.050
Organization: Preparation and contents of articles of incorporation. 695A.060
Organization: Filing of documents and bond with Commissioner 695A.070
Organization: Solicitation of members 695A.080
Certificate of authority: Issuance and renewal 695A.090
General powers and duties of society. 695A.095
Contracts between society and provider of health care: Prohibiting society from charging provider of health care fee for inclusion on list of providers given to insureds 695A.110
Unincorporated or voluntary association prohibited. 695A.120
Location of principal office 695A.130
Consolidation 695A.140
Conversion of fraternal benefit society into mutual life insurer. 695A.150
Qualifications for and rights and privileges of membership. 695A.151
Effect of eligibility for medical assistance under Medicaid on eligibility for coverage 695A.152
Society required to comply with certain provisions concerning portability and availability of health insurance. 695A.153
Society prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order. 695A.155
Certain accommodations to be made when child is covered under policy of noncustodial parent. 695A.157
Society to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances 695A.159
Society prohibited from restricting coverage of child based on preexisting condition when person who is eligible for group coverage adopts or assumes legal obligation for child. 695A.160
Amendment of laws of society. 695A.180
Scope of contractual benefits. 695A.184
Coverage for prescription drug previously approved for medical condition of insured. 695A.188
Approval or denial of claim 695A.195
Society prohibited from denying coverage solely because person was victim of domestic violence. 695A.197
Society prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance 695A.200
Nonforfeiture benefits, cash surrender values, certificate loans and other options. 695A.210
Beneficiaries 695A.220
Benefits not liable to attachment, garnishment or other process. 695A.230
Terms and conditions of benefit contracts. 695A.232
Requirements regarding issuance of health benefit plans and adjustment of costs. 695A.235
Offering policy of health insurance for purposes of establishing health savings account. 695A.240
Approval and contents of certificates. 695A.255
Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 695A.265
Coverage for services provided through telehealth. 695A.270
Waiver of provisions of society’s laws. 695A.280
Reinsurance. 695A.300
Admission of foreign or alien society. 695A.310
Injunction against, liquidation of or appointment of receiver for domestic society. 695A.320
Suspension, revocation or refusal of license of foreign or alien society. 695A.330
Licensing of insurance agents of society 695A.400
Service of process on society. 695A.410
Injunctions against societies. 695A.420
Judicial review of Commissioner’s findings and decisions. 695A.430
Assets, funds and accounts of society. 695A.440
Investments. 695A.450
Annual statement of financial condition, transactions and affairs. 695A.460
Penalties for failure to file statement properly. 695A.475
Liability of directors, officers, employees, members and volunteers 695A.490
Standards of valuation for certificates. 695A.500
Examination of societies transacting business in State. 695A.530
Applicability of statutory provisions relating to trade practices and frauds. 695A.550
Exemption of societies from certain taxes. 695A.555
Fees: Applicability of certain provisions. 695A.560
Exemption of societies from other insurance laws. 695A.570
Applicability. 695A.580
Penalties. 695A.1845
Required coverage for certain tests and vaccines relating to human papillomavirus 695A.1855
Coverage for mammograms for certain women 695A.1857
Benefit contract that includes coverage for maternity care must not deny coverage to gestational carrier 695A.1865
Coverage for drug or device for contraception and related health services in certain circumstances 695A.1873
Coverage for management and treatment of sickle cell disease. 695A.1875
Coverage for certain services, screenings and tests relating to wellness
Last Updated

Jun. 24, 2021

§ 695A.184’s source at nv​.us