Nevada § 422.403 - Establishment and management of use by Medicaid program of step therapy and prior authorization; exception for certain drugs to treat psychiatric conditions; duties of Drug Use Review Board; acceptance of recommendations from Board; regulations

§ 422.403. Establishment and management of use by Medicaid program of step therapy and prior authorization; exception for certain drugs to treat psychiatric conditions; duties of Drug Use Review Board; acceptance of recommendations from Board; regulations

1. The Department shall, by regulation, establish and manage the use by the Medicaid

program of step therapy and prior authorization for prescription drugs. 2. The Drug Use Review Board shall: (a) Advise the Department concerning the use by the Medicaid program of step therapy

and prior authorization for prescription drugs; (b) Develop step therapy protocols and prior authorization policies and procedures

for use by the Medicaid program for prescription drugs; and (c) Review and approve, based on clinical evidence and best clinical practice guidelines

and without consideration of the cost of the prescription drugs being considered,

step therapy protocols used by the Medicaid program for prescription drugs. 3. The step therapy protocol established pursuant to this section must not apply to

a drug approved by the Food and Drug Administration that is prescribed to treat a

psychiatric condition of a recipient of Medicaid, if: (a) The drug has been approved by the Food and Drug Administration with indications

for the psychiatric condition of the insured or the use of the drug to treat that

psychiatric condition is otherwise supported by medical or scientific evidence; (b) The drug is prescribed by: (1) A psychiatrist; (2) A physician assistant under the supervision of a psychiatrist; (3) An advanced practice registered nurse who has the psychiatric training and experience

prescribed by the State Board of Nursing pursuant to NRS 632.120 ; or (4) A primary care provider that is providing care to an insured in consultation with

a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner

listed in subparagraph (1), (2) or (3) who participates in Medicaid is located 60

miles or more from the residence of the recipient; and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based

on the medical history of the recipient, or reasonably expects each alternative drug

that is required to be used earlier in the step therapy protocol to be ineffective

at treating the psychiatric condition. 4. The Department shall not require the Drug Use Review Board to develop, review or

approve prior authorization policies or procedures necessary for the operation of

the list of preferred prescription drugs developed pursuant to NRS 422.4025 . 5. The Department shall accept recommendations from the Drug Use Review Board as the

basis for developing or revising step therapy protocols and prior authorization policies

and procedures used by the Medicaid program for prescription drugs. 6. As used in this section: (a) “ Medical or scientific evidence ” has the meaning ascribed to it in NRS 695G.053 . (b) “ Step therapy protocol ” means a procedure that requires a recipient of Medicaid to use a prescription drug

or sequence of prescription drugs other than a drug that a practitioner recommends

for treatment of a psychiatric condition of the recipient before Medicaid provides

coverage for the recommended drug.