{"data":{"id":"us-nv/nrs-687b.4095","jurisdiction":"us-nv","citation":"NRS 687B.4095","heading":"Policies of health insurance including prescription drug coverage: Restrictions on moving prescription drug from lower-cost tier to higher-cost tier.","body":"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:\n(a) On January 1; and\n(b) On any date on which the insurer adds to the formulary a generic prescription drug that:\n(1) Has been approved by the Food and Drug Administration for use as an alternative to the original prescription drug; and\n(2) Is being added to the formulary at:\n(I) The same cost tier from which the original prescription drug is being moved; or\n(II) A cost tier which has a smaller deductible, copayment or coinsurance than the cost tier from which the original prescription drug is being moved.\n2. 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:\n(a) On January 1;\n(b) On July 1; and\n(c) On any date on which the insurer adds to the formulary a generic prescription drug that:\n(1) Has been approved by the Food and Drug Administration for use as an alternative to the original prescription drug; and\n(2) Is being added to the formulary at:\n(I) The same cost tier from which the original prescription drug is being moved; or\n(II) A cost tier which has a smaller deductible, copayment or coinsurance than the cost tier from which the original prescription drug is being moved.\n3. An insurer who issues a policy of health insurance described in subsection 1 or 2 and who removes a prescription drug from a formulary shall not, in the same plan year in which the prescription drug was removed, add the prescription drug back to the formulary in a higher cost tier except in accordance with the provisions of subsection 1 or 2, as applicable.\n4. Except as otherwise provided in subsection 3, the provisions of this section do not prevent an insurer, at any time, from:\n(a) Moving a prescription drug from a higher cost tier of a formulary to a lower cost tier of the formulary;\n(b) Removing a prescription drug from a formulary; or\n(c) Adding a prescription drug to a formulary.\n5. This section does not apply to a grandfathered plan.\n6. 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:\n(a) A generic drug for a drug prescribed by brand name; or\n(b) An interchangeable biological product for a biological product prescribed by brand name.\n7. As used in this section:\n(a) “Biological product” has the meaning ascribed to it in NRS 639.0017.\n(b) “Individual carrier” has the meaning ascribed to it in NRS 689A.550.\n(c) “Insurer” includes, without limitation:\n(1) An individual carrier; and\n(2) A governmental entity which offers, administers or otherwise provides a policy of health insurance.\n(d) “Interchangeable biological product” has the meaning ascribed to it in NRS 639.00855.\n(e) “Small employer” has the meaning ascribed to it in NRS 689C.095.","path":["TITLE 57 — INSURANCE","CHAPTER 687B - CONTRACTS OF INSURANCE","GENERAL PROVISIONS"],"source_url":"https://www.leg.state.nv.us/NRS/NRS-687B.html#NRS687BSec4095","current_through":"2025 session (NRS as revised 2026-08-25)","vintage":"","retrieved_at":"2026-09-03T05:51:46Z","sha256":"4026d9a354f652dccdaf0c01bbf5d033fe7851dc7de6d6a6d312cdcb9092b0b1","source_id":"us-nv","stale":true,"prev":"us-nv/nrs-687b.409","next":"us-nv/nrs-687b.410"},"notice":"GroundRules: Original legal text. Not legal advice."}