Nevada Senate Bill 317 – which introduces major changes to the state’s workers’ compensation system – has been signed into law by Governor Joe Lombardo.
Originally aimed at expanding provider choice, the bill now mandates a closed drug formulary, strengthens oversight of provider panels, and eases in-state office requirements for insurers and third-party administrators (TPAs).
The bill requires the Division of Industrial Relations (DIR) to adopt the Official Disability Guidelines (ODG Drug Formulary – or its successor – by July 1, 2027. Coverage for non-formulary drugs is allowed through January 1, 2028.
Insurers are prohibited – with certain exceptions – from providing reimbursement for a drug that is not listed and approved on the formulary, when use of the formulary is required. Injured workers can however appeal to a hearings officer any determination denying a request for a drug which has been recommended as medically necessary.
As for provider panels, insurers must verify that providers in their panels are accepting patients, they must update treating provider lists within 60 days of changes, and they must submit updates annually. TPAs may file on behalf of multiple insurers.
Furthermore, insurers and TPAs can meet the in-state office requirement by designating a legal representative with an office in Nevada.
The implementation of a workers’ comp formulary in Nevada will allow for greater cost containment while also promoting evidence-based care.
