Nevada Senate Bill 317, a large workers’ compensation bill, was recently signed into law. Among its multiple provisions, the bill includes the requirement for the state’s Division of Industrial Relations (DIR) to adopt the Official Disability Guidelines (ODG) Drug Formulary on or before July 1, 2027, as the formulary to be used by insurers for workers’ compensation claims. SB 317 also provides several basic requirements with respect to the related authorization and denial appeal process and sets forth other relevant implementation and transition dates.
Basic formulary requirements
As the official formulary for workers’ compensation claims, the bill requires DIR to:
- Adopt the ODG formulary on or before July 1, 2027
- Make the formulary available on a publicly accessible website as soon as practicable after adoption
- Update the website as necessary with current information relating to the formulary.
Workers’ comp insurers will be required to use the adopted formulary for any drug that is prescribed or dispensed to an injured worker for outpatient services but not for prescription drugs that are prescribed or dispensed for emergency medical services or inpatient services.
Except as otherwise provided in the law, the insurer is not to provide reimbursement for any drug listed but not approved, or omitted from, the formulary. However, insurers will be permitted to provide reimbursement for those categories of drugs if they have elected to approve the drug in their established procedures and in compliance with any applicable requirements that may be established by DIR.
If a physician believes a drug is medically necessary, but it is listed but not approved, or omitted from, the formulary and has not been approved by the insurer, they may submit an authorization request to the insurer. If the insurer denies the authorization request, the injured worker or their representative may appeal that denial to a hearings officer.
Other relevant dates
The bill provides several additional dates that will impact the scope of and application of the formulary, including a transition period.
Until January 1, 2028, an insurer may reimburse an impacted drug that is dispensed to an injured worker after July 1, 2027, if:
- The injured worker sustained the injury on or between January 1, 2027, and July 1, 2027; and
- The injured worker was originally prescribed the drug in connection with their claim on or between January 1, 2027, and July 1, 2027.
The amendments in SB 317 apply to any claim which is open, filed or reopened on or after the date of the bill’s passage and approval. The bill was approved by the governor on June 10, 2025.
Moving forward
While the bill outlines several requirements and dates, details on its implementation will be developed later through rulemaking by DIR. It may be important to also note that the Occupational Medicine Practice Guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM) have already been adopted as medical treatment guidelines in the existing DIR rules. It is not yet known whether that will change. Nevada would not, however, be the first state to have adopted the ODG formulary but use treatment guidelines not from ODG.
The MyMatrixx by Evernorth Regulatory Affairs team will be monitoring and engaging in that rulemaking process, and our clinical teams will also be paying close attention. The basic requirements and prescribed dates in the bill should guide the rulemaking, so those should be reviewed in anticipation of eventual implementation and compliance by stakeholders.
Questions on this bill or other public policy topics for our Regulatory Affairs team can be sent to MMXRegulatoryAffairs@MyMatrixx.com. For the status of other recent legislation or regulations related to formularies or prior authorization across the country that we are tracking, refer to our Legislative and Regulatory Policy Tracker on our Statehouse Watch webpage (select “Formulary” or “Prior Authorization” as the topic and limit the category to “Workers’ Compensation” if only interested in those that may impact workers’ comp). For more information on policy developments in workers’ compensation impacting pharmacy across the country, please visit and bookmark Statehouse Watch at MyMatrixx.com.