Section 422.403 - Establishment and management of use by Medicaid program of step therapy and prior authorization; duties of Drug Use Review Board; exception for certain drugs to treat psychiatric conditions; acceptance of recommendations from Board; regulations1. The Department shall, by regulation, establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.2. The Drug Use Review Board shall: (a) Advise the Department concerning the use by the Medicaid program of step therapy and prior authorization for prescription drugs;(b) Develop step therapy protocols and prior authorization policies and procedures for use by the Medicaid program for prescription drugs; and(c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.3. The step therapy protocol established pursuant to this section must not apply to a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of a recipient of Medicaid, if:(a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence; (b) The drug is prescribed by: (2) A physician assistant under the supervision of a psychiatrist;(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120; or(4) A primary care provider that is providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in Medicaid is located 60 miles or more from the residence of the recipient; and(c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the recipient, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.4. The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed pursuant to NRS 422.4025.5. The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.6. As used in this section: (a) "Medical or scientific evidence" has the meaning ascribed to it in NRS 695G.053.(b) "Step therapy protocol" means a procedure that requires a recipient of Medicaid to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the recipient before Medicaid provides coverage for the recommended drug.Added to NRS by 2003, 1318; A 2019, 4029; 2023, 1792Amended by 2023, Ch. 269,§15, eff. 7/1/2023.Amended by 2019, Ch. 616,§31.45, eff. 1/1/2020.Added to NRS by 2003, 1318