Senate Bill No. 474

Senate Bill No. 474-Committee on Human Resources and Facilities

CHAPTER

442

AN ACT relating to the administration of Medicaid; requiring the welfare division of the department of human resources to study the feasibility of establishing an electronic system for the management of pharmaceutical claims; authorizing the welfare division to contract for the provision of pharmaceutical services through managed care under certain conditions; and providing other matters properly relating thereto.

[Approved July 16, 1997]

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. 1. In carrying out its duties regarding the administration of Medicaid, the welfare division of the department of human resources shall:
(a) Study the feasibility of establishing an electronic system for the management of pharmaceutical claims that provides for:
(1) The on-line adjudication of pharmaceutical claims;
(2) The review of the use of pharmaceutical services;
(3) The review of pharmaceutical therapy at the point of sale to identify potential problems in that therapy, including, without limitation, any incorrect dosage, adverse interaction, contraindication, therapeutic duplication, incorrect duration of treatment and clinical abuse or misuse; and
(4) If necessary, the ability to link to and share appropriate information with managed care organizations that enter into contracts with the welfare division; and
(b) On or before September 1, 1998, submit its findings and recommendations to the legislative committee on health care.
2. The legislative committee on health care shall:
(a) Review the findings and recommendations of the welfare division; and
(b) On or before January 31, 1999, submit the findings and recommendations of the legislative committee on health care to the 70th session of the Nevada legislature.
Sec. 2. 1. On or before October 1, 1999, except as otherwise provided in subsection 3, in carrying out its duties regarding the administration of Medicaid, the welfare division of the department of human resources may enter into a contract for the provision of pharmaceutical services through managed care to recipients of Medicaid if the welfare division and the legislative committee on health care determine that such a contract:
(a) Is cost effective;
(b) Is the most convenient method of providing pharmaceutical services to the recipients of Medicaid; and
(c) Includes access to pharmacies licensed in this state to the maximum extent possible.
2. If the welfare division enters into a contract pursuant to subsection 1, except for any limitations on coverage provided pursuant to 42 U.S.C. § 1396r-8(d)(2) or (6), the contract must provide for reimbursement for the dispensing of a drug to a recipient of Medicaid, without requiring any prior or retroactive approval, if the drug:
(a) Has been approved or designated as safe and effective by the Food and Drug Administration; and
(b) Is prescribed by a physician who determines that the drug is appropriate for the diagnosis or treatment of the recipient of Medicaid.
3. The provisions of this section do not apply to a contract that provides services only to recipients who are eligible to receive benefits pursuant to:
(a) The program established to provide temporary assistance for needy families pursuant to Title IV of the Social Security Act (42 U.S.C. §§ 601 et seq.) and other provisions of that act relating to temporary assistance for needy families; or
(b) The child health assurance program established pursuant to 42 U.S.C. § 1396a(a)(10)(A)(i)(IV), (VI) or (VII).
Sec. 3. This act becomes effective upon passage and approval.
________