Nevada Code § 422.27172

State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to family planning; reimbursement of pharmacist for certain family planning services
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1. The Director shall include in the State
Plan for Medicaid a requirement that the State pay the nonfederal share of
expenditures incurred for:
(a) Up to a 12-month supply, per prescription, of
any type of drug for contraception or its therapeutic equivalent which is:
(1) Lawfully prescribed or ordered;
(2) Approved by the Food and Drug
Administration; and
(3) Dispensed in accordance with NRS 639.28075 ;
(b) Any type of device for contraception which is
lawfully prescribed or ordered and which has been approved by the Food and Drug
Administration;
(c) Self-administered hormonal contraceptives
dispensed by a pharmacist pursuant to NRS
639.28078 ;
(d) Insertion or removal of a device for
contraception, including, without limitation, the insertion of such a device at
a hospital immediately after a person gives birth;
(e) A contraceptive injection, including, without
limitation, such an injection immediately after a person gives birth;
(f) Education and counseling relating to the
initiation of the use of contraceptives and any necessary follow-up after
initiating such use;
(g) Management of side effects relating to
contraception; and
(h) Voluntary sterilization for women.
2. Except as otherwise provided in
subsections 4 and 5, to obtain any benefit provided in the Plan pursuant to
subsection 1, a person enrolled in Medicaid must not be required to:
(a) Pay a higher deductible, any copayment or
coinsurance; or
(b) Be subject to a longer waiting period or any
other condition.
3. The Director shall ensure that the
provisions of this section are carried out in a manner which complies with the
requirements established by the Drug Use Review Board and set forth in the list
of preferred prescription drugs established by the Authority pursuant to NRS 422.4025 .
4. The Plan may require a person enrolled
in Medicaid to pay a higher deductible, copayment or coinsurance for a drug for
contraception if the person refuses to accept a therapeutic equivalent of the
contraceptive drug.
5. For each method of contraception which
is approved by the Food and Drug Administration, the Plan must include at least
one contraceptive drug or device for which no deductible, copayment or
coinsurance may be charged to the person enrolled in Medicaid, but the Plan may
charge a deductible, copayment or coinsurance for any other contraceptive drug
or device that provides the same method of contraception. If the Plan requires
a person enrolled in Medicaid to pay a copayment or coinsurance for a drug for
contraception, the Plan may only require the person to pay the copayment or
coinsurance:
(a) Once for the entire amount of the drug
dispensed for the plan year; or
(b) Once for each 1-month supply of the drug
dispensed.
6. The Plan must provide for the
reimbursement of a pharmacist for providing services described in subsection 1
that are within the scope of practice of the pharmacist to the same extent as
if the services were provided by another provider of health care. The Plan must
not limit:
(a) Coverage for such services provided by a
pharmacist to a number of occasions less than the coverage for such services
when provided by another provider of health care.
(b) Reimbursement for such services provided by a
pharmacist to an amount less than the amount reimbursed for similar services
provided by a physician, physician assistant or advanced practice registered
nurse.
7. The Plan must not require a recipient
of Medicaid to obtain prior authorization for the benefits described in
paragraphs (a) and (c) of subsection 1.
8. As used in this section:
(a) Drug Use Review Board has the meaning
ascribed to it in NRS 422.402 .
(b) Provider of health care has the meaning
ascribed to it in NRS 629.031 .
(c) Therapeutic equivalent means a drug which:
(1) Contains an identical amount of the
same active ingredients in the same dosage and method of administration as
another drug;
(2) Is expected to have the same clinical
effect when administered to a patient pursuant to a prescription or order as
another drug; and
(3) Meets any other criteria required by
the Food and Drug Administration for classification as a therapeutic
equivalent.

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