Policies of health insurance including prescription drug coverage: Restrictions on moving prescription drug from lower-cost tier to higher-cost tier.
Nev. Rev. Stat. § 687B.4095
in effect1. If a policy of health insurance issued to an individual pursuant to chapter 689A , 695B or 695C of NRS includes coverage for a prescription drug pursuant to a formulary with more than one cost tier, the insurer may move the prescription drug from a lower cost tier to a higher cost tier only:
(a) On January 1; and
(b) On any date on which the insurer adds to the formulary a generic prescription drug that:
(1) Has been approved by the Food and Drug Administration for use as an alternative to the original prescription drug; and
(2) Is being added to the formulary at:
(I) The same cost tier from which the original prescription drug is being moved; or
(II) A cost tier which has a smaller deductible, copayment or coinsurance than the cost tier from which the original prescription drug is being moved.
2. If a policy of health insurance issued to a small employer pursuant to chapter 689C , 695B or 695C of NRS includes coverage for a prescription drug pursuant to a formulary with more than one cost tier, the insurer may move the prescription drug from a lower cost tier to a higher cost tier only:
(a) On January 1;
(b) On July 1; and
(c) On any date on which the insurer adds to the formulary a generic prescription drug that:
(1) Has been approved by the Food and Drug Administration for use as an alternative to the original prescription drug; and
(2) Is being added to the formulary at:
(I) The same cost tier from which the original prescription drug is being moved; or
(II) A cost tier which has a smaller deductible, copayment or coinsurance than the cost tier from which the original prescription drug is being moved.
3. An insurer who issues a policy of health insurance described in subsection 1 or 2 and who removes a prescription drug from a formulary shall not, in the same plan year in which the prescription drug was removed, add the prescription drug back to the formulary in a higher cost tier except in accordance with the provisions of subsection 1 or 2, as applicable.
4. Except as otherwise provided in subsection 3, the provisions of this section do not prevent an insurer, at any time, from:
(a) Moving a prescription drug from a higher cost tier of a formulary to a lower cost tier of the formulary;
(b) Removing a prescription drug from a formulary; or
(c) Adding a prescription drug to a formulary.
5. This section does not apply to a grandfathered plan.
6. The provisions of this section must not be construed to limit the conditions under which a pharmacist is otherwise authorized or required by law to substitute:
(a) A generic drug for a drug prescribed by brand name; or
(b) An interchangeable biological product for a biological product prescribed by brand name.
7. As used in this section:
(a) Biological product has the meaning ascribed to it in NRS 639.0017 .
(b) Individual carrier has the meaning ascribed to it in NRS 689A.550 .
(c) Insurer includes, without limitation:
(1) An individual carrier; and
(2) A governmental entity which offers, administers or otherwise provides a policy of health insurance.
(d) Interchangeable biological product has the meaning ascribed to it in NRS 639.00855 .
(e) Small employer has the meaning ascribed to it in NRS 689C.095 .
Source: NV Statutes (Official Site)URL: https://www.leg.state.nv.us/nrs/NRS-687B.htmlFetched: 10/4/2026