1. Except as otherwise provided in subsection 2, the Authority shall directly manage, direct and coordinate all payments and rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Childrens Health Insurance Program. 2. The Authority may enter into a contract with: (a) A pharmacy benefit manager for the provision of any services described in subsection 1. (b) A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 for recipients of Medicaid or recipients of insurance through the Childrens Health Insurance Program who receive coverage through a Medicaid managed care program. (c) One or more public or private entities from this State, the District of Columbia or other states or territories of the United States for the collaborative purchasing of prescription drugs in accordance with subsection 3 of NRS 277.110 . 3. A contract entered into pursuant to paragraph (a) or (b) of subsection 2 must: (a) Include the provisions required by NRS 422.4056 ; (b) Require the pharmacy benefit manager or health maintenance organization, as applicable, to disclose to the Authority any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid and any fees and charges imposed by the pharmacy benefit manager or health maintenance organization pursuant to the contract; and (c) Require the pharmacy benefit manager or health maintenance organization to comply with the provisions of this chapter regarding the provision of prescription drugs under the State Plan for Medicaid and the Childrens Health Insurance Program to the same extent as the Authority. 4. In addition to meeting the requirements of subsection 3, a contract entered into pursuant to: (a) Paragraph (a) of subsection 2 may require the pharmacy benefit manager to provide the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Authority, to the Authority. (b) Paragraph (b) of subsection 2 must require the health maintenance organization to provide to the Authority the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Authority, less an administrative fee in an amount prescribed by the contract. The Authority shall adopt policies prescribing the maximum amount of such an administrative fee. NRS 422.4053 Management of payments, rebates and provision of other services relating to prescription drugs; contract with state pharmacy benefit manager for certain services; authority to contract with certain other entities. [Effective on the effective date of the initial contract entered into between the Nevada Health Authority and the state pharmacy benefit manager pursuant to NRS 422.4053 , as amended by section 12 of chapter 390, Statutes of Nevada 2025, at page 2605 .] 1. The Authority shall: (a) Evaluate applications received pursuant to NRS 422.40523 and choose an applicant to serve as the state pharmacy benefit manager; and (b) Enter into a contract with the state pharmacy benefit manager chosen pursuant to paragraph (a) to, except as otherwise provided in subsection 2: (1) Manage, direct and coordinate payments and rebates for any prescription drugs included on the list of preferred prescription drugs developed pursuant to NRS 422.4025 , any other prescription drugs listed in the contract and all other services and payments relating to the provision of such prescription drugs under the State Plan for Medicaid, the Childrens Health Insurance Program and the other health benefit plans described in subsection 1 of NRS 422.4025 ; and (2) If the Board of State Prison Commissioners so elects pursuant to NRS 209.111 , purchase prescription drugs through the agreements entered into pursuant to paragraph (e) of subsection 3 on behalf of the Department of Corrections. 2. The Authority may enter into a contract with: (a) A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 through the contract entered into pursuant to subsection 5 of NRS 422.273 for recipients of Medicaid or recipients of insurance through the Childrens Health Insurance Program who receive coverage through a Medicaid managed care program. (b) One or more public or private entities from this State, the District of Columbia or other states or territories of the United States for the collaborative purchasing of prescription drugs in accordance with subsection 3 of NRS 277.110 . 3. The contract entered into pursuant to subsection 1 must: (a) Include the provisions required by NRS 422.4056 ; (b) Require the state pharmacy benefit manager to disclose to the Authority any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid, any fees and charges imposed by the state pharmacy benefit manager pursuant to the contract and any other sources of payment received by the state pharmacy benefit manager for prescription drugs covered by the contract; (c) Require the state pharmacy benefit manager to comply with the provisions of this chapter regarding the provision of prescription drugs under the State Plan for Medicaid and the Childrens Health Insurance Program to the same extent as the Authority; (d) Require the state pharmacy benefit manager to comply with all other applicable state and federal laws; (e) Require the state pharmacy benefit manager to negotiate and enter into agreements to purchase the drugs included on the list of preferred prescription drugs developed pursuant to NRS 422.4025 , except where those drugs are purchased through a contract entered into pursuant to subsection 2; and (f) Require the state pharmacy benefit manager to provide the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Authority, to the Authority. 4. In addition to meeting the requirements of subsection 3, a contract entered into pursuant to subsection 1 must prohibit the state pharmacy benefit manager from: (a) Using spread pricing; (b) Paying a pharmacy a professional dispensing fee for a drug which is less than the applicable dispensing fee established pursuant to NRS 422.40527 , if the applicable dispensing fee established pursuant to that section has been included in the State Plan for Medicaid and approved by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; (c) Creating, modifying, implementing or indirectly establishing any fee to be imposed upon a pharmacy, a pharmacist or a recipient of benefits under the contract without first seeking and obtaining written approval from the Authority; (d) Requiring a recipient of benefits under the contract to obtain a specialty drug from a specialty pharmacy owned by or otherwise associated with the state pharmacy benefit manager; (e) Requiring a recipient of benefits under the contract to use a specific pharmacy; and (f) Requiring a recipient of benefits under the contract to use a mail order pharmacy or Internet pharmacy. 5. A contract entered into with a health maintenance organization pursuant to paragraph (a) of subsection 2 must: (a) Include the provisions required by NRS 422.4056 ; (b) Require the health maintenance organization to disclose to the Authority any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and any fees and charges imposed by the health maintenance organization imposed by the contract; (c) Require the health maintenance organization to comply with the provisions of this chapter regarding the provision of prescription drugs under the State Plan for Medicaid and the Childrens Health Insurance Program to the same extent as the Authority; and (d) Require the health maintenance organization to provide to the Authority the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Authority. 6. As used in this section: (a) Internet pharmacy has the meaning ascribed to it in NRS 639.00865 . (b) Professional dispensing fee has the meaning ascribed to it in 42 C.F.R. 447.502. (c) Spread pricing means any technique by which a pharmacy benefit manager charges or claims an amount from an insurer for drugs or services provided by a pharmacy or pharmacist that is different from the amount the pharmacy benefit manager pays the pharmacy or pharmacist, as applicable, for those drugs or services.
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