Reimbursement by insurer for drugs listed but not approved on or omitted from formulary. [Effective July 1, 2027.]
Nev. Rev. Stat. § 616C.119
in effect1. Except as otherwise provided in this section, if an insurer, pursuant to subsection 2 of NRS 616C.118 , is required to use the formulary adopted pursuant to that section, the insurer shall not provide reimbursement for any drug if the drug is listed but not approved, or omitted from, the formulary.
2. An insurer described in subsection 1 may provide reimbursement for a drug that is listed but not approved, or omitted from, the formulary if the insurer has elected to approve the drug in accordance with procedures established by the insurer and in compliance with any applicable requirements that may be established by the Administrator.
3. If a physician or chiropractic physician believes the drug is medically necessary for an injured employee, the physician or chiropractic physician may submit a request to an insurer described in subsection 1 for authorization to prescribe to the injured employee a drug which is listed but not approved, or omitted from, the formulary adopted pursuant to NRS 616C.118 and which has not been approved by the insurer pursuant to subsection 2. If the insurer approves the request, the insurer may provide reimbursement for the drug.
4. If the insurer denies the request of a physician or chiropractic physician pursuant to subsection 3, the injured employee or his or her representative may appeal the determination of the insurer to a hearing officer in the manner provided by NRS 616C.315 .
Source: NV Statutes (Official Site)URL: https://www.leg.state.nv.us/nrs/NRS-616C.htmlFetched: 10/4/2026