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Sponsors say AB259 would extend Medicare-negotiated drug prices to non-Medicare patients; PBMs and industry warn of fiscal and access risks
Summary
Assembly Bill 259 would extend certain Medicare-negotiated maximum fair prices under the federal Inflation Reduction Act to non-Medicare Nevada residents for a limited set of high-cost drugs. The sponsor said the bill targets life-sustaining, noncompetitive medicines; public employee and state health officials and PBM representatives warned the
CARSON CITY — Assembly Bill 259, which would seek to extend Medicare-negotiated maximum fair prices (MFP) for a small group of high-cost, noncompetitive drugs to non-Medicare Nevada patients, drew debate on Friday in the Assembly Ways and Means Committee over fiscal impacts and implementation mechanics.
Sponsor Assemblymember Venisha Considine said the bill aims to reduce the cost of "certain high cost, non competitive, life changing drugs" by applying the federal Medicare-negotiated prices under the Inflation Reduction Act to non-Medicare residents who need a limited set of life-sustaining medicines. Considine said an earlier version was vetoed in 2023 and that this session a fiscal note from the Public Employees' Benefits Program (PEBP) now exists.
Celestina Glover, executive officer for PEBP, told the committee that PEBP's pharmacy benefits manager, Express Scripts (ESI), calculated a projected net cost increase and estimated a roughly $1.50 per member per month increase across all covered lives, which PEBP said would translate to approximately $1,000,000 in FY26–27 and roughly $1.8 million in future biennia given the plan's covered population.
Dr. Duncan, pharmacy director at the Division of Health Care Finance and Policy, described the fiscal impact to the state general fund as "indeterminable" and possibly significant. He said limiting price negotiation to a subset of drugs could shift utilization and affect supplemental drug rebates that benefit the state's general fund.
Opponents called the bill fiscally risky or operationally unworkable. The Biotechnology Innovation Organization (BIO) urged the committee to oppose AB259, arguing that state-level price caps tied to a federally determined MFP could disrupt market and purchasing arrangements and risk patient access. The Nevada Society of Health-System Pharmacists said pharmacies and hospitals would be forced to buy drugs at wholesale prices and could lose money or decline to stock drugs absent a federal transaction framework like Medicare's. PhRMA's state policy director, calling in opposition, cited PEBP's fiscal estimates and external studies that estimated implementation costs if the state must create new infrastructure similar to the federal mechanism.
Sponsor Considine responded that the bill's intent is to "bypass the pharmacy benefit manager kickback rebate program" for those limited drugs and that the negotiated price should be the price for patients the bill targets.
The committee closed the hearing; no formal action was taken on the bill during the session.
Ending: The hearing raised implementation questions about PBMs, rebates and whether Nevada can extend federal negotiated prices without creating state-level infrastructure. Agencies provided differing fiscal estimates; sponsors emphasized the bill addresses cost and access for people taking costly, life-sustaining medicines.
