Revises provisions governing the administration of pharmacy benefits under Medicaid. (BDR 38-224)
SB149 would overhaul how Nevada administers pharmacy benefits for Medicaid, the Children’s Health Insurance Program, and certain other public health benefit plans that use the Medicaid preferred drug list. Instead of allowing the Department of Health and Human Services to contract with a pharmacy benefit manager, a health maintenance organization, or other entities, the bill requires the Department to select and contract with a single “state pharmacy benefit manager” to manage prescription drug payments, rebates, and related services. The bill also requires Medicaid managed care organizations to use that state pharmacy benefit manager for pharmacy benefits provided through managed care.
The bill adds detailed application, contracting, reporting, and oversight requirements. Applicants must disclose conflicts of interest, ownership relationships, and fees imposed on pharmacies and pharmacists. The Department must adopt regulations setting eligibility criteria, reimbursement methodology, and dispensing fees, including rules that may vary by pharmacy type if federal law allows. Contracts must prohibit spread pricing, certain fee structures, and steering patients to specific pharmacies or mail-order services, and must require claims transmission, rebate pass-through, and a fiduciary duty to the Department. The bill also requires annual audits and public reporting of audit results and financial effects.
SB149 would also change how pharmacy contracts are reviewed and enforced. The state pharmacy benefit manager must submit pharmacy and network contracts, revisions, suspensions, and terminations to the Department for approval before they become effective. The Department may impose a civil penalty of $25,000 per day for certain violations, including actions taken to avoid paying pharmacies amounts owed for services already rendered. The bill further preserves and updates existing step-therapy exemption procedures for certain cancer patients, shifting administration to the state pharmacy benefit manager where applicable.
In terms of state-law impact, SB149 amends multiple provisions in Chapter 422 of NRS and makes conforming changes to the state’s Medicaid pharmacy-benefit framework. It also creates an exception in the state’s 340B pharmacy benefit manager restrictions so that the new state pharmacy benefit manager is not subject to those provisions when administering Medicaid pharmacy benefits. Existing contracts entered into before January 1, 2026, are grandfathered until their current terms expire, after which the new state pharmacy benefit manager would assume those responsibilities.
Because there were no committee transcripts or recorded votes provided, the overall sentiment cannot be measured from debate or roll-call history. Based on the bill text alone, the measure appears designed to increase state control, transparency, and pharmacy reimbursement protections, which suggests support for pharmacies and oversight advocates. Potential points of contention are likely to include the shift to a single state-selected manager, the Department’s expanded authority over private contracts, the prohibition on spread pricing and related pricing practices, the treatment of vertically integrated pharmacy benefit managers, and the operational and fiscal burden of implementing a new statewide model.
SB149 would significantly revise Nevada’s Medicaid pharmacy-benefit statutes by replacing the Department’s current contracting flexibility with a mandatory state pharmacy benefit manager model. It would amend NRS 422.273, 422.4025, 422.4032, 422.4053, 422.4056, and related provisions, while also creating new sections governing eligibility, conflicts disclosure, reimbursement rules, contract approval, and penalties. The bill would affect Medicaid, CHIP, Medicaid managed care organizations, pharmacies, pharmacists, and pharmacy benefit managers, and it would require new regulations and administrative oversight beginning immediately for preparation and on January 1, 2026, for operative effect.
No committee discussion or vote history was provided, so there is no recorded legislative sentiment to summarize from hearings or floor action. From the bill’s structure, the measure appears generally favorable to pharmacy reimbursement transparency, state oversight, and limits on PBM practices such as spread pricing and patient steering. At the same time, the bill’s broad restructuring of pharmacy-benefit administration suggests it could draw concern from managed care organizations, pharmacy benefit managers, and entities affected by new reporting, approval, and contracting restrictions.
The main likely points of contention are the bill’s requirement that the Department select a single state pharmacy benefit manager, the extensive disclosure of ownership and conflict information, and the prohibition on spread pricing, indirect remuneration, and pharmacy steering. Stakeholders representing PBMs or managed care organizations may object to the Department’s power to approve pharmacy contracts and alter payment arrangements, while pharmacies and patient advocates may support those provisions as protections against underpayment and restrictive network practices. The bill’s interaction with 340B entities and its potential impact on vertically integrated PBMs and affiliated pharmacies are also likely to be debated.