Committee hears debate on AB 186 to expand pharmacists’ scope; fiscal note revised

Assemblymember David Orentlicher presented AB 186 to the Ways and Means Committee as a measure intended to expand the scope of practice for pharmacists so they can diagnose and treat certain minor conditions and bill for specified services.

Sponsor and supporters said the measure is designed to increase access to care amid workforce shortages. Jennifer Lanahan of the Nevada Pharmacy Alliance and Liz McMenamin of the Retail Association of Nevada testified in support, citing access advantages from pharmacies’ broad reach and hours.

Opponents included the Nevada Psychiatric Association, Nevada Advanced Practice Nurses Association (NAFNA), the Nevada section of the American College of Obstetricians and Gynecologists, and the Nevada State Medical Association. Leah Cartwright of the Nevada Psychiatric Association raised concerns that laboratory tests cannot diagnose mental illness and warned of risks that patients might receive refills or treatment without appropriate psychiatric oversight. Janine Packham of NAFNA described safety protocols used in the VA to ensure oversight and said pharmacists there operate within detailed collaborative procedures. Jacqueline Nguyen of the Nevada State Medical Association said the bill as drafted could enable practice of medicine by providers who are not clinically trained to do so and noted the CLIA list of tests.

Medicaid staff described a revised fiscal note and potential federal matching funds. Anne Jensen of Nevada Medicaid said matching federal dollars would cover the federal share of Medicaid benefits that are subject to federal regulations. Jensen said the department identified savings because some lab services now billed by physicians could be billed by pharmacists after an 18-month ramp-up; she estimated pharmacists could bill for up to 65% of a subset of those lab services by the end of ramp-up, producing the savings shown in the fiscal analysis. Committee staff reported different posted totals: an originally posted state total of $295,391 (FY 2025–26) and $571,860 (FY 2026–27), while an updated “computable” total posted later was $1,072,710 (FY 25–26) and $1,187,541 (FY 26–27). Jensen clarified the state general fund impact would be $296,752 in FY 2026 and $287,774 in FY 2027, with a larger federal share referenced across the biennium.

Why it matters: The bill would change who may provide and bill for certain diagnostic and treatment services, shifting some services out of physician settings into pharmacies and changing state and federal Medicaid spending patterns.

Discussion vs. decision: The committee conducted a policy and fiscal hearing and invited testimony from supporters and opponents. No committee vote on AB 186 was recorded in this session; the hearing was closed for Ways and Means.

Ending: The sponsor said stakeholders had worked to narrow the bill and asked the committee to consider the changes; the hearing was closed.