Nevada bill would expand pharmacists’ authority to test, treat and prescribe; supporters point to access while medical groups raise safety concerns

Assemblymember David Orentlicher introduced Assembly Bill 186 to expand the services pharmacists may provide in Nevada, saying the state’s shortage of primary care clinicians makes greater use of pharmacists necessary to deliver timely care.

"We need to ensure that our healthcare professionals can practice to the full extent of their expertise and skill set," Orentlicher said. The bill would let pharmacists prescribe for conditions that do not require a new diagnosis, perform and interpret CLIA-waived tests such as strep or flu, order and interpret certain laboratory work, furnish contraceptives and immunizations in statute, and prescribe in limited emergency situations.

Ken Kunke, a practicing pharmacist and executive director of the Nevada Pharmacy Alliance, described key elements and guardrails in AB186: limiting prescribing to FDA-approved drugs, giving the State Board of Pharmacy authority to adopt regulations and training requirements, authorizing pharmacists to serve as laboratory director for CLIA-waived testing in pharmacies, and ensuring standard-of-care obligations.

"A CLIA waived test are those tests that are determined by the CDC or FDA to be so simple that there are little risk of error," Ken Kunke said, adding that tests analogous to pregnancy tests have been safely used and that the pandemic has already shown pharmacists can perform and act on certain test results.

Industry supporters — including representatives from Albertsons Companies, Nevada Health Centers, the Nevada Society of Health System Pharmacists and retail pharmacy leaders — urged passage. Liz Moyer, an Idaho-based pharmacist with Albertsons, described Idaho’s experience in which pharmacies treat minor conditions, administer tests and bill insurers for clinical visits in some cases. "Allowing pharmacists to prescribe medications for common conditions would provide a safe and convenient and immediate solution for families," Moyer said.

Supporters pointed to Nevada workforce data cited in testimony: Nevada ranks 48th for primary care supply (testimony cited a ranking of "40 eighth out of 50" in the presentation; presenters emphasized all counties face shortages) and about 2,700 pharmacists reside in the state. Presenters said most pharmacists hold Doctor of Pharmacy degrees and receive roughly 1,740 hours of clinical training during professional education, with many completing residencies or certifications.

Opponents included the Nevada Psychiatric Association, the Nevada State Medical Association and emergency physicians who said the bill risks delegating medical assessments that can require full history and physical exams. Dr. Nehal Neik, a board-certified emergency physician, said that tests such as rapid strep or a urinalysis do not replace an emergency physician’s assessment for complications such as peritonsillar abscess or pyelonephritis. "When I see someone with a strep throat, I need to examine the patient to make sure they don't have a life-threatening illness," Neik said.

The Nevada Association of Health Plans and others testified in neutral, asking for clearer rules on recordkeeping, credentialing and how pharmacies would submit medical claims (medical vs. pharmacy benefit). Several committee members asked whether regulations would be required before pharmacists could begin services; Dave Weese, executive secretary of the State Board of Pharmacy, said the board expects to adopt regulations and that a typical regulatory implementation would take months, with six months offered as a rough example. That timeline would also require review by the Legislative Commission for regulations.

Members raised questions about controlled substances: board and sponsor representatives said the bill as written could allow certain controlled substances for limited treatment (for example medications for opioid use disorder) but emphasized that standard-of-care and regulatory guardrails would limit inappropriate prescribing for pain. Committee members also pressed on malpractice and reimbursement implications; supporters noted experience in other states shows gradual rollout and that employer/insurer credentialing and billing practices often evolve after statutes change.

No formal votes were taken at the hearing. Sponsors said they would work on technical amendments and regulatory guardrails before any work session.

Ending: The committee heard extensive, mixed testimony and requested clarifications on training, documentation, regulation timelines and the treatment of controlled substances; supporters said other states’ experiences show safe implementation.