Insurers use a state drug list for workers’ compensation prescriptions

Insurers use Nevada’s adopted drug formulary for outpatient prescriptions. The rules cover outpatient drugs prescribed or dispensed for injured employees’ workers’ compensation claims. The formulary does not have to be used for drugs prescribed or dispensed for emergency or inpatient care. Insurers may approve a drug outside the formulary under their procedures. A doctor may request approval for a medically necessary drug, and the worker may appeal a denial. The formulary rules take effect July 1, 2027, and the Administrator must adopt the formulary by that date. Until January 1, 2028, insurers may still cover certain drugs dispensed after July 1, 2027, if the injury and original prescription both fall from January 1 through July 1, 2027.

Insurers maintain and file lists of doctors and mental health providers for injured workers to choose from. These lists cover doctors and mental health providers who agree to treat injured workers under the workers’ compensation system. In counties with populations of at least 100,000, doctor lists must meet the required numbers and include doctors with active practices and physical offices in that county; mental health lists must include at least 12 providers. Doctors may be removed only under the stated rules, including their request, certain contract cancellations, listed causes, or a periodic insurer audit. If a doctor is removed and the list needs a replacement to meet its requirements, the insurer has 60 days. Workers may choose from the state panel if the insurer’s list does not meet the requirements. Insurers update and file both kinds of lists each year from September 1 through October 1. Starting September 1, 2026, insurers may audit doctor lists every three calendar years and remove doctors of their choosing from the list filed by October 1 of that year.

The law sets proof rules for stress-related claims and requires mental health provider lists for those claims. These rules apply to employees claiming compensation for a stress-related injury or disease, with separate tests for first responders and government employees responding to mass casualty incidents. Most claims require clear and convincing medical, psychological, or psychiatric evidence of a mental injury caused by extreme stress in time of danger, a work event as the primary cause, and no cause related to layoff, termination, or discipline. Separate rules cover first responders who directly witness specified deaths or grievous injuries, and state or local government employees whose extreme stress is primarily caused by responding to a designated mass casualty incident. Agencies must provide first responders with mental health education and training. Insurers update and submit mental health provider lists each year from September 1 through October 1.

The Subsequent Injury Account pays for certain combined disabilities or deaths only when the later workplace injury occurred by September 30, 2025. This account covers claims for employees of associations of self-insured public or private employers. The worker must have a qualifying preexisting permanent impairment, and the combined effects must make the disability substantially greater than the later injury alone would have caused. For reimbursement, the employer must have known about the impairment when hiring the worker or kept the worker after learning of it. Separate rules address a worker’s false statement about their physical condition. The later injury must occur on or before September 30, 2025; injuries on or after October 1, 2025, do not qualify for this account.

Insurers issue a first payment or payment decision for temporary partial disability claims within 14 working days. This rule applies to injured employees claiming temporary partial disability under workers’ compensation. The deadline applies when an injured employee makes a claim for temporary partial disability. The 14-working-day period starts when the insurer receives the claim.