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Nevada hearing on AB 186 would let pharmacists treat minor conditions; fiscal questions and medical groups push back
Summary
A Ways and Means hearing on AB 186 sought funding and fiscal clarity for a proposal to allow pharmacists to diagnose and treat certain minor conditions. Supporters said federal matching dollars would cover much of the cost; several medical groups testified in opposition citing patient-safety concerns and limits of CLIA-waived tests.
Assemblymember David Orr-Allen (sponsor) told the Assembly Ways and Means Committee that AB 186 would expand pharmacy practice in Nevada so pharmacists can diagnose and treat specified minor conditions such as strep throat, conjunctivitis and cold sores, a change he said would increase access where doctors and other clinicians are scarce.
The bill’s fiscal implications were central to the hearing. Anne Jensen of Nevada Medicaid told the committee that the Medicaid program expects federal matching dollars to cover the large majority of the state’s share and described an implementation ramp of about 18 months. Jensen said updated estimates posted on NELIS show $1,072,710 total computable for FY 2025–26 and $1,187,541 for FY 2026–27; she also said the state general fund portion would be roughly $296,752 in FY 2026 and $287,774 in FY 2027 under current assumptions.
Supporters told the committee the change is safe and would expand access. Jennifer Lanahan of the Nevada Pharmacy Alliance and Adam Porath of the Nevada Society of Health System Pharmacists urged lawmakers to fund the bill and said pharmacies, federally qualified health centers and other providers support the change. Liz McMenamin of Veil Association in Nevada pointed to national trends and said Nevada would join about two dozen other states allowing expanded pharmacist scope.
Several health-care provider groups opposed AB 186 on safety grounds. Leah Cartwright of the Nevada Psychiatric Association warned that no laboratory tests diagnose mental illness and said the bill risks inappropriate medication refills. Jeannine Packham of the Nevada Advanced Practice Nurses Association described safeguards used in her VA practice and said pharmacists there operate under detailed standard operating procedures that loop in primary care providers; she said those safeguards reflect collaborative clinical oversight that a standalone authorization in statute might not ensure. Sarah Adler representing the Nevada section of the American College of Obstetricians and Gynecologists said eye redness has many causes and should not be presumed a simple diagnosis without full clinical context. Jacqueline Nguyen, representing the Nevada State Medical Association, said the bill goes “far beyond” current practice and noted that more than 1,400 tests appear on federal CLIA lists, arguing the proposal risks delegating medical diagnosis to clinicians who do not have the full scope of clinical training.
Sponsor response and next steps: Assemblymember Orr-Allen said he and stakeholders worked to narrow the bill’s scope and that the amended language limits pharmacists to services within their training. Committee members did not take a final vote during the hearing; the committee closed the hearing and left funding and final drafting decisions for subsequent work sessions.
Ending: Committee staff and fiscal witnesses said they would provide additional detail if requested; the committee closed the AB 186 hearing and moved on to other items on the Ways and Means agenda.
