Senate committee considers banning step therapy for HIV and hepatitis C drugs to speed access to treatment

Senate Bill 354, presented Thursday to the Nevada Senate Committee on Commerce and Labor by Senator Jeff Stone (Senate District 20), would bar insurers and Nevada Medicaid from requiring step therapy ("try‑and‑fail" protocols) for specific medications used to treat or prevent HIV and to cure hepatitis C.

Stone said the bill is a public‑health measure designed to remove time‑consuming hurdles that can delay viral suppression for people living with HIV and to speed curative hepatitis C treatment. “HIV is not a disease where try and fail is an appropriate barrier,” Stone told the committee, noting that rapid and appropriate treatment reduces transmission and improves long‑term outcomes.

Nut graf: Sponsors and clinicians said removing step therapy for these conditions protects patients and public health by preventing avoidable transmission and by enabling treatment that reduces lifetime costs; insurers said they support patient access but asked for further dialogue about utilization and cost controls.

Dr. Leana Ramirez, chief clinical officer at The Center in Las Vegas, described clinical and personal impacts. She told senators that long‑acting injectable HIV treatments can spare patients daily reminders of trauma and improve adherence; she also cited statewide data presented in testimony that Nevada ranked fifth highest in the nation for new HIV diagnoses as of February 2022 (cited in testimony as "20 new cases per 100,000 people") and that Clark County accounts for more than 80 percent of those new diagnoses. On hepatitis C, witnesses cited a prevalence figure from testimony described as "approximately 11 90 cases per 100,000 people." The testimony said hepatitis C is curable with direct‑acting antivirals typically completed in about eight weeks.

Supporters also noted the avoided costs if early, appropriate treatment prevents advanced disease: testimony cited a U.S. liver transplant cost exceeding $875,000 and hepatitis C drug courses ranging from about $25,000 to $94,000, and one witness cited estimated lifetime savings from early HIV treatment at roughly $225,000 per patient.

The bill drew support from community health providers, the Retail Association of Nevada’s pharmacy members, the Nevada Primary Care Association and advocacy groups. The Nevada Association of Health Plans testified it was open to working with sponsors but cautioned that step therapy programs are an established utilization‑management tool designed to promote safety, quality and cost‑effective prescribing; the association said carriers use pharmacy and therapeutics committees to set protocols and that expedited appeals are available when a prior therapy is inappropriate.

Adam Plain of the Nevada Division of Insurance testified neutral, noting the division previously analyzed Senate Bill 439 (2023) and determined that mandates related to HIV and hepatitis C had triggered federal defrayal provisions for plan year 2025. Plain said the division lacks robust data on how removing step therapy would change utilization and costs, and suggested a possible implementation delay (for example shifting an effective date from 2026 to 2027) to allow the state's essential health‑benefit benchmark update process to incorporate any mandated benefits and avoid federal defrayal exposure.

No committee vote was taken. Senator Stone said he was open to further discussions with insurers and stakeholders about technical changes.

Ending: The committee closed the SB 354 hearing and moved to public comment; sponsors and stakeholders were asked to continue negotiating technical details.

Speakers quoted above are drawn from testimony before the Senate Committee on Commerce and Labor.