Nevada § 422.27172 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to family planning; reimbursement of certain pharmacists for family planning services

§ 422.27172. State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to family planning; reimbursement of certain pharmacists for family planning services

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 Department

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.