NV SB209

Pharmacy benefit managers (PBMs) are prohibited from requiring patients to use affiliated pharmacies when nonaffiliated pharmacies are available in the network, and from discriminating against nonaffiliated pharmacies in reimbursement rates or contract terms.

PBMs must pass through 100% of manufacturer rebates to either the covered person at point-of-sale to reduce cost-sharing, or to the insurer, and are banned from using "spread pricing" (charging insurers more than they pay pharmacies for the same drug).

Insurers receiving rebate money from PBMs must use those funds solely to reduce premiums and cost-sharing obligations for covered persons.

PBMs must submit annual reports to the Commissioner of Insurance detailing pricing information, rebates, fees, and contracts for the top 50 drugs by cost, frequency, and revenue; the Commissioner must compile biennial public reports on PBM impact on drug costs.

Pharmacies may sue PBMs for $5,000 per violation plus attorney's fees if a PBM retaliates against them for reporting potential legal violations; the bill takes effect January 1, 2026.