Bill > AB249

Introduced Session

Legislative Counsel's Digest: Existing law requires most health insurance plans which cover prescription drugs and outpatient care to also include coverage for contraceptive drugs and devices without an additional copay, coinsurance or a higher deductible than that which may be charged for other prescription drugs and outpatient care under the plan. (NRS 689A.0415, 689A.0417, 689B.0376, 689B.0377, 695B.1916, 695B.1918, 695C.1694, 695C.1695) Certain plans, including small employer plans, benefit contracts provided by fraternal benefit societies, plans issued by a managed care organization and certain plans offered by governmental entities of this State are not currently subject to these requirements. (Chapters 287, 689C, 695A and 695G of NRS) The federal Patient Protection and Affordable Care Act, Pub. L. 111-148, as amended, requires certain contraceptive drugs, devices and services to be covered by every health insurance plan without any copay, coinsurance or higher deductible. (42 U.S.C. 300gg-13(a)(4); 45 C.F.R. 147.130) The provisions of this bill do not require a public or private insurer to provide coverage for the purpose of terminating a pregnancy. Sections 3, 4 and 7-25 of this bill align Nevada law with federal law, requiring all public and private health insurance plans made available in this State to provide coverage for certain benefits relating to contraception without any copay, coinsurance or a higher deductible. Sections 3, 4 and 7-25 require certain contraceptive drugs, devices and services which are approved by the Food and Drug Administration to be covered by a health insurance plan, including, without limitation, up to a 12-month supply of a drug for contraception or its therapeutic equivalent, insertion of a device for contraception, removal of such a device that was inserted while the insured was covered by the same policy of health insurance, education and counseling relating to contraception, management of side effects relating to contraception and voluntary sterilization for women. Sections 3, 4 and 7-25 allow an insurer to require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug. In addition, a health insurance plan must include for each method of contraception which is approved by the Food and Drug Administration and for which the insurer is required to provide coverage at least one contraceptive drug or device for which no deductible, copayment or coinsurance may be charged to the insured. Sections 3, 4 and 7-25 authorize an insurer to use medical management techniques to determine the frequency of treatment using the contraceptive drugs, devices and services required by this bill. Sections 3, 4 and 7-25 prohibit an insurer from using medical management techniques to require an insured to use a method of contraception other than that prescribed by a provider of health care. Sections 3, 4 and 7-25 additionally require an insurer to provide a process by which an insured may request an exemption from a medical management technique required by an insurer. Sections 3, 4 and 7-25 also require a health insurance plan to provide coverage for certain therapeutic equivalent drugs relating to contraception when a therapeutic equivalent covered by the plan is deemed to be medically inappropriate by a provider of health care. Additionally, sections 7, 11, 14, 16, 17, 20 and 25 require that the benefits provided by a health insurance plan relating to contraception which are provided to the insured must also be provided to a covered dependent of an insured. Existing law allows an insurer which is affiliated with a religious organization and which objects on religious grounds to providing coverage for contraceptive drugs and devices to exclude coverage in its policies, plans or contracts for such drugs and devices. (NRS 689A.0415, 689B.0376, 695B.1916, 695C.1694) Sections 7, 11, 14, 16, 17, 20 and 25 of this bill move the religious exemption coverage for the contraceptive drugs, devices and services required by this bill to the new provisions relating to coverage of contraception. Existing law requires this State to develop a State Plan for Medicaid which includes, without limitation, a list of the medical services provided to Medicaid recipients. (42 U.S.C. 1396a; NRS 422.063) Existing federal law authorizes a state to charge a copay, coinsurance or deductible for most Medicaid services, but prohibits any copay, coinsurance or deductible for certain contraceptive drugs, devices and services. (42 U.S.C. 1396o-1) Existing federal law also authorizes a state to define the parameters of contraceptive coverage provided under Medicaid. (42 U.S.C. 1396u-7) Existing Nevada law requires a number of specific medical services to be covered under Medicaid. (NRS 422.2717-422.27241) Section 1 of this bill requires the State Plan for Medicaid to include certain benefits relating to contraception currently required to be covered by private health insurance plans pursuant to existing Nevada law and the Patient Protection and Affordable Care Act, Pub. L. 111-148, as amended, as well as certain additional benefits related to contraception required by sections 3, 4 and 7-25 of this bill without any copay, coinsurance or deductible in most cases. The benefits relating to drugs for contraception which are provided by section 1 of this bill are subject to step therapy and prior authorization requirements pursuant to existing law. Existing law authorizes a pharmacist to dispense up to a 90-day supply of a drug pursuant to a valid prescription or order in certain circumstances. (NRS 639.2396) Section 4.5 of this bill requires a pharmacist to dispense up to a 12 month supply of drugs for contraception or a therapeutic equivalent thereof pursuant to a valid prescription or order if: (1) the patient has previously received a 3-month supply of the same drug; (2) the patient has previously received a 9-month supply of the same drug or a supply of the same drug for the balance of the plan year in which the 3-month supply was prescribed or ordered, whichever is less; (3) the patient is insured by the same health insurance plan; and (4) a provider of health care has not specified in the prescription or order that a different supply of the drug is necessary.

Teresa Benitez-Thompson (D)*,  Shannon Bilbray-Axelrod (D)*,  Jason Frierson (D)*,  Michael Sprinkle (D)*,  Steve Yeager (D)*,  Elliot Anderson (D),  Nelson Araujo (D),  Christopher Brooks (D),  Irene Bustamante Adams (D),  Maggie Carlton (D),  Richard Carrillo (D),  Lesley Cohen (D),  Skip Daly (D),  Olivia Diaz (D),  Edgar Flores (D),  Osvaldo Fumo (D),  Sandra Jauregui (D),  Amber Joiner (D),  William McCurdy (D),  Brittney Miller (D),  Daniele Monroe-Moreno (D),  Dina Neal (D),  James Ohrenschall (D),  Ellen Spiegel (D),  Heidi Swank (D),  Tyrone Thompson (D),  Justin Watkins (D), 

Approved by the Governor. Chapter 553. (on 06/12/2017)

Official Document