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From YouTube: 3/31/2023 - Senate Committee on Commerce and Labor
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A
A
A
That
noise,
you
hear,
are
the
gears
on
the
bus.
Okay,
so
I
want
to
welcome
everybody
here
this
morning
whose
work
well
I
can
talk.
Who
is
with
us
in
Carson,
City
and
I.
A
Don't
see
anybody
in
Las
Vegas,
but
in
case
you
come
there's
a
welcome
on
the
table
and
those
who
are
visiting
with
us
of
the
computer
and
telephone
a
couple
of
housekeeping
items
to
go
over
and
let
me
do
mine
first
make
sure
that
you've
turned
your
phone
off
or
on
mute
so
that
it
doesn't
disturb
anyone
who
might
be
testifying,
and
if
mine
goes
off,
then
that
would
be
hypocritical
right.
A
Yeah
here
we
go
boom
there
we
go
I
mean
there
are
a
couple
of
different
ways
actually
for
different
ways
that
you
can
participate.
You
can
do
it
here.
You
can
do
it
in
Las
Vegas.
You
can
do
it
telephonically.
You
can
submit
written
comments
or
you
can
share
your
opinion
on
our
opinion
poll
and
all
exhibits
and
I
just
have
to
keep
saying
this.
In
case
you
have
a
hearing
coming
up
and
you're
going
to
have
some
exhibits.
A
Please
please,
please
have
them
submitted
by
eight
o'clock
the
day
before
it's
impossible
for
our
committee
manager
to
try
to
correlate
everything
and
get
everything
up
on
Nellis
when
you
do
it
the
day
of
so
make
sure
you
turn
them
in.
Excuse
me
by
eight
o'clock
the
day
before
when
you
testify.
Please
turn
your
microphone
on
state,
your
name
and
entity.
You
represent,
and
please
project
your
voice
so
that
everyone
can
hear
you.
Those
who
are
are
listening
over
the
internet
and
I
get
I
get
comments.
All
the
time
I
couldn't
hear
them.
A
I
couldn't
hear
them
so
make
sure
your
project,
your
voice,
speaking
to
the
mic,
when
you
finish
speaking,
turn
off
the
mic
reminder
to
all
those
who
testify
pursuing
to
Nevada
revised
attitude,
NRS
to
18e.085,
it's
unlawful
for
a
person
to
knowingly
misrepresent
facts
when
testifying
before
a
legislative
committee,
a
person
who
knowingly
does
so
is
guilty
of
a
misdemeanor.
In
addition,
both
the
chair
and
members
May
request
any
testifier
to
submit
documentation
supporting
their
testimony.
All
committee
related
information
is
available
on
Nellis,
which
is
accessible
from
the
legislature's
website.
A
We'll
take
public
comment
at
the
end
of
the
meeting,
but
please
note
the
public
comment
is
only
two
minutes
and
public
comment
should
not
will
not
cannot
contain
anything
that
we
talked
about
during
the
hearing
of
any
of
the
other
bills
and
again.
Finally,
please
do
like
me
turn
your
phones
either
off
or
put
them
on
silent,
okay,
and
so
with
that
we
will
begin
with
Senator
orenshaw
Senate,
Bill
194,
and
the
measure
revises
Provisions
relating
to
step
therapy
protocols.
C
Good
morning,
chair
Spearman
members
of
the
committee
for
the
record,
James
orenshaw
represents
State
Senate,
District
21
down
in
southern
Nevada.
Thank
you
for
hearing
Senate
Bill
194
I
really
appreciate
your
hearing
this
bill.
This
is
Bill,
which
I
think
has
the
potential
to
really
benefit
our
constituents,
our
constituents
who
are
finding
illnesses.
C
This
is
a
bill
aimed
at
expanding
and
streamlining
the
process
of
requesting
exemptions
from
Step
therapy
protocols
for
prescription
drugs,
as
well
as
ensuring
that
these
Protocols
are
based
on
solid
medical
and
scientific
evidence.
As
most
of
you
know,
step
therapy
or
sometimes
called
fail.
First
is
a
practice
used
by
insurers.
That
requires
patients
to
try
lower
cost
medications
before
allowing
them
other
treatments
that
their
doctors,
Health,
Care
Providers
may
have
wanted
them
to
have
that
are
more
costly
for
commercial
or
private
Health.
C
C
Healthcare
practitioners
usually
prescribe
the
most
effective
treatment
for
their
patients,
but
may
not
place
a
priority
on
prescribing
lower
costing
treatments.
A
healthcare
practitioner
May
simply
not
have
the
pricing
information
from
the
patient's
health
insurance
to
be
able
to
prescribe
a
more
inexpensive
but
still
effective
treatment.
Health
insurers
covered
prescription
drugs
are
included
in
lists
called
formularies.
C
Some
health
insurers,
May
divide
these
lists
into
preferred
or
non-preferred
lists.
While
others
use
a
tiered
system
when
using
a
tiered
system.
Prescription
drugs
are
categorized
based
on
the
type
of
prescription
drug
such
as
generic
drugs
preferred
brand
name,
drugs,
non-preferred,
brand
name,
drugs
and
Specialty
drugs.
C
Often,
patients
pay
the
lowest
copay
for
drugs
listed
in
the
first
year
and
the
highest
in
the
last
year.
During
discussions
concerning
step
therapy,
reform
cost
is
justifiably
at
the
Forefront
the
most
common
concerns
the
legislature
has
when
looking
at
similar
reforms
has
been
how
this
will
impact
premiums
for
our
constituents
and
the
state.
C
A
2019
analysis
of
silver
level
plans
in
states
where
step
therapy
reform
laws
have
been
enacted,
found
that
there
was
no
change
in
the
cost
of
premiums
in
those
States
compared
to
premiums
and
states.
Without
such
laws,
I
believe
Senate,
Bill
194
will
accomplish
many
of
the
goals
that
we've
seen
in
other
states
in
trying
to
help
our
constituents
IT
addresses
concerns
related
to
insurance
companies,
step
therapy
protocols,
which
can
sometimes
result
in
delays
or
denial
of
necessary
treatments
for
patients,
especially
those
with
serious
conditions.
C
Existing
law
already
enables
patients
to
request
an
exemption
from
Step
therapy
protocols
established
by
their
insurers
for
prescription
drugs
used
to
treat
late
stage
cancer
or
related
symptoms.
This
is
based
on
the
groundwork
groundbreaking
work
of
my
colleague,
Senator
Lang
last
session.
Senate
Bill
194
proposes
to
extend
this
provision
requiring
certain
private
sector
insurers
to
create
a
process
for
insured
individuals
and
their
attending
practitioners
to
request
an
exemption
from
any
step
therapy
protocol,
as
well
as
to
appeal
a
decision
regarding
that
request
for
an
exemption
from
Step
therapy
protocol
under
Senate
Bill
194.
C
Those
insurers
would
be
required
to
either
Grant
the
request.
If
the
attending
attending
practitioner
submits
adequate
justification
for
the
exemption
or
to
give
good
reason
why
that's
being
denied,
furthermore,
the
bill
mandates
that
this
exemption
process
and
the
submission
of
an
appeal
would
be
accessible
via
the
insurance
company's
website.
C
In
addition
to
expanding
the
exemption
process,
Senate
Bill
194
ensures
that
private
sector
insurers
use
guidelines
based
on
medical
or
scientific
evidence,
When
developing
step
therapy
protocols.
This
is
an
important
measure
to
guarantee
that
patients
receive
the
most
effective
treatments
based
on
the
best
available
evidence.
C
Senate
Bill
194
does
not
extend
to
Medicaid
or
Managed
Care
organizations
share
with
your
permission,
I
wonder
if
I
could
turn
it
over
to
Hannah
and
Lucy,
who
are
here
to
talk
about
some
of
the
struggles
they've
faced
in
their
lives
and
then
I'd
be
happy
to
answer
any
questions
about
Senate
bill.
184.
D
Hi,
my
name
is
Hannah
Grosso
and
I'm
here
to
talk
about
the
step
therapy
bill
and
the
dangers
of
it.
Now
I
was
diagnosed
with
ulcerative
colitis
when
I
was
two
years
old,
and
for
years
we
tried
several
treatments,
including
a
biologic
named
Remicade.
Now
none
of
that
worked,
and
at
eight
years
old,
my
parents
and
I
made
the
difficult
decision
for
me
to
have
my
entire
large
intestine
removed
for
a
few
years.
I
was
lucky
enough
to
have
no
symptoms,
but
around
my
sophomore
year
of
high
school
I
started
to
have
Crohn's
symptoms.
D
Around
2018
I
was
officially
diagnosed
with
crohn's
disease,
which
meant
that
the
next
step
was
to
begin
figuring
out
a
medication
for
these
next
several
months,
I
had
debilitating
symptoms.
That
often
stop
me
from
attending
school
or
having
any
form
of
a
social
life,
and
for
those
of
you
who
don't
do
not
know
the
IBD
symptoms
are
not
pretty
stomach
pain,
nausea,
joint
pain,
weight
loss,
pretty
much
everything
in
the
book
now.
This
is
where
step
therapy
comes
into
my
life.
D
D
That
year
was
one
of
the
worst
times
of
my
life,
in
which
I
had
symptoms
that
only
got
worse.
I
was
unable
to
attend
school
and
I
had
to
get
a
504
plan
due
to
the
amount
of
school
and
extracurriculars.
That
I
was
missing
to
those
of
you
who
have
children.
Imagine
watching
them
suffer
and
knowing
that
you
can
do
nothing
about
it,
but
knowing
that
there
is
a
medicine
out
there
that
can
help
them
Insurance,
just
won't
let
them.
D
D
Now
I
was
lucky
in
the
fact
that
stellara
was
able
to
help
put
me
into
remission,
but
a
lot
of
other
people
are
not
so
lucky.
Studies
have
shown
that
step
therapy
has
led
to
an
increased
risk
of
hospitalizations
and
worsened
symptoms,
often
times
after
going
through
step
therapy.
Patient
symptoms
have
worsened
so
bad
to
the
point
that
that
medicine
they
were
trying
to
prescribe
them,
won't
work
anymore,
which
means
that
those
patients
then
have
to
go
through
step
therapy
all
over
again.
D
It
needs
to
be
passed
so
that
all
individuals
with
chronic
illnesses
can
get
the
treatment
that
they
deserve
to
have
to
be
able
to
live
their
fullest
lives.
It's
my
hope
that
this
bill
will
be
passed
to
spare
anyone
else
from
going
through
what
me
and
millions
of
other
patients
have
had
to
go
through.
Thank
you.
E
Thank
you,
Hannah
for
sharing.
My
name
is
Lucy
I
I
represent
the
national
psoriasis
foundation
and
I.
Also
am
a
patient
with
crohn's
disease
like
Hannah,
so
I
speak
both
as
a
patient
and
as
a
staff
member
for
a
non-profit.
So
with
this
bill.
E
What
is
important
to
note
is
that,
due
to
Senator
Lang's
incredible
work
last
session,
we
have
seen
this
type
of
legislation
be
successful
in
late
stage
cancer
and
it's
important
to
note
that
we
are
expanding
it
to
all
disease
States,
so
that
folks
of
any
disease
State
can
re
request
that
exemption
process,
and
that
is
important
to
note
because,
as
Hannah
pointed
out,
this
is
critical
in
the
realm
of
chronic
illness,
with
folks
with
psoriasis
and
psoriatic
arthritis
who
I
represent
at
the
national
psoriasis
Foundation.
E
E
More
severe
symptoms
that
then
cannot
be
remedied
as
quickly
as
they
could
have
been
if
they
had
been
on
the
on
the
prescription
originally
prescribed
by
them.
It's
important
to
us
that,
as
Senator
arenchal
pointed
out
that
these
decisions
are
made
by
the
prescribing
doctor
and
a
group
of
peers,
not
by
the
insurance
companies,
because
cost
is
not
the
only
thing
that
comes
into
play
when
dealing
with
chronic
illness.
We
need
to
look
at
Patients
symptoms
what's
best
for
them,
what's
worked
for
them
in
the
past
and
what
the
professionals
believe
will
work
for
them.
E
It's
not
fair
that
a
patient
would
have
to
try
a
medication
that
they
have
already
tried
and
failed
in
the
past
or
is
expected
to
fail.
Personally.
I
have
been
I've
was
diagnosed
with
crohn's
disease
a
little
over
10
years
ago,
and
in
that
10
years,
I've
tried
about
seven
different
medications
and
six
out
of
seven
of
those
medications
did
not
work
for
me
and
I.
Finally,
am
on
a
medication.
A
biologic
that
has
put
me
into
remission
and
I
have
had
stable
health
for
the
first
time
in
my
life.
E
If
I
were
to
change
insurance
policies
and
be
subjected
to
step
therapy,
there
is
a
possibility
that
I
would
have
to
go
back
and
try
those
medications
that
I
already
failed
medications.
That
put
me
in
the
hospital
medications
that
put
me
into
flare-ups
and
those
being
on
a
medication
that
doesn't
work
properly
for
you
and
can
cause
severe
health
effects
and
potential
hospitalization
that
doesn't
cut
costs.
E
It
is
more
expensive
to
have
to
go
to
the
hospital
or
have
to
then
receive
surgery,
because
your
medication
didn't
work.
Then,
if
you
had
just
been
on
the
medication
that
was
prescribed
for
you
in
the
first
place,
and
you
didn't
have
to
experience
those
detrimental
health
effects
I.
Thank
you
both
for
for
your
comments.
That's
all
I
have
to
say.
C
Chair
members
of
committee,
James,
orenshaw,
States,
Senate,
District
21,
just
want
to
reiterate
Senate
Bill
194
would
not
prohibit
and
insure
from
having
step
therapy
protocols.
It
would
provide
this
exemption
process.
This
appeals
process
and
a
quick
reply
from
the
insurance
company
as
to
trying
to
get
the
medication
that
the
health
care
provider
believes
would
be
best
for
that
patient
I'm
happy
to
answer
any
questions.
A
Thank
you,
you
mean
any
questions.
F
F
So
just
a
couple
of
questions,
and
maybe
some
of
your
guys
can
come
talk
to
me
after
the
committee
and
various
things,
so
I'm
not
going
to
deny
that
there
are
issues
with
the
step
therapy,
protocols
and
various
things,
but
I
the
way.
I
read
it.
Yes,
there's
they
have
to
do
the
response
and
you
have
to
do
it
very
quickly
and
various
things,
but
it
doesn't.
F
It
says
they
shall
granted
if
they
get
a
statement
or
if
there's
this
justification
and
then,
if
the
justification
exists,
when
I
read
it,
it
says
that
that
they
have
to
Grant
it
and
I'm,
not
saying
that's
bad.
If
you've
tried
a
drug
before
I
agree,
100
percent,
you
know
you
shouldn't
have
to
try
it
again
because
you
switched
insurance.
I
know
we
had
that
on
the
a
different
Bill
earlier
in
in
this
session,
along
that
along
those
lines
and
that's
how
most
insurance
companies
do
that.
F
So
is
there
a
little
more
leeway
because
the
way
I
read
this?
It's
very
you
have
to
do
it
and
if
you
get
this
evidence
you
still
have
to
do
it.
There's
not
really.
You
say
they
can
do
a
denial,
but
there's
I
don't
really
see
that
very
strongly
in
there.
Not
that
I'm
saying
the
insurance
companies
are
innocent.
I'm,
just
saying
that
there
has
to
be
a
fair
process.
F
If
there's
this
statement
in
documentation
right,
which
seems
fairly
one-sided,
then
it
says
if
you
get
the
statement
of
various
things,
that
they
have
to
make
a
determination
and
I'm
like
I,
say
I'm,
not
arguing
with
you
that
these
cases
need
to
be
fixed,
I
agree
with
you,
but
then
it
says
when
they
make
their
determination.
If
they've
received
the
statement
and
documentation,
they
can't
say
no
the
way
it
reads.
C
James
orange
Senator
Daley,
that's
the
way
the
bill
is
written
and
I
believe
the
bill
in
the
long
run
will
benefit
patients
and
benefit
insurance
companies,
and
that's
certainly
I'm
open
to
discussions
with
Senator
Daley,
but
I
believe
that
this
will
lead
to
positive
outcomes.
The
current
process
outlined
in
the
legislation.
F
However,
you
know
we
have
the
similar
formulary
various
things.
We
try
to
get
people
to
use
the
generic
drug
and
based
on
our
plan,
design.
The
way
we
do
it
is
when
you
go
to
you,
don't
have
a
copay.
You
pay
20,
because
it's
part
of
the
major
medical.
So
when
you
show
up
to
the
pharmacist
with
the
drug
that
they
prescribed
and
it's
eight
hundred
dollars,
they
go
back
to
the
doctor
and
say:
hey:
is
there
something?
F
That's
going
to
work
in
this
their
first
time,
they're
trying
it
if
they've
been
on
a
drug
and
they've
tried
it
before
they
switched
insurance
or
they
didn't
tolerate
the
other
one.
They
have
an
appeal
process
and
we
almost
universally
Grant
those
that's
our
plan.
I
can't
speak
for
some
of
the
others,
though,
but
if
it's
you
have
to
do
it,
that's
what
I'm
saying
it's
a
little
one-sided
and
I,
just
that's
where
I
read
it
anyway.
So
I'd
like
to
talk
to
you
after.
E
Do
want
to
note
that
the
language
that
we
are
using
in
this
bill
is
model
language
and
has
been
used
in
36
laws
around
the
United
States
for
similar
bills,
and
we
have
seen
it
be
successful
in
other
states
as
well,
and
one
note
that
I
that
I
want
to
make
is
that
we
did
make
sure
to
include
that
specific
language
that
the
insurance
company
has
to
Grant
or
deny,
rather
than
just
the
insurance
company,
has
to
respond
to
a
patient
in
a
certain
amount
of
time,
because
we
wanted
to
ensure
that
patients
would
receive
a
clear
answer
within
that
time
frame
so
that
the
process
would
not
be
dragged
on.
E
We
felt
that
if
it
said
that
the
insurance
company
had
to
respond
Within,
X
time
frame
that
that
gave
them
wiggle
room
to
not
actually
appeal
or
deny
the
the
appeals
process.
So
we
just
wanted
to
have
that
language
in
there
to
hold
the
insurance
companies
more
accountable
and
get
a
more
clear
and
efficient
response
from
the
insurance
companies.
F
C
Share
with
your
permission,
James
orange
Alsina,
District
21.
I
just
want
to
point
Senator
Daley
to
the
language
which
is
repeats
throughout
the
bill,
the
different
sections
of
the
insurers,
who
would
be
effective
under
Senate
Bill
194,
but
in
section
one.
If
we
look
at
sub
3
starting
at
lines,
29
through
33
of
the
attending
practitioner
for
the
insured
submits
the
insurer
statement,
which
provides
an
adequate
justification
for
the
exemption
and
any
documentation
necessary
to
support
the
statement.
The
insurer
shall
determine
that
such
justification
exists
if
the
statement
and
documentation
demonstrate.
C
So
if
anything,
the
final
decision
here
is
with
the
insurer
as
to
whether
they
believe
that
that
adequate
justification
has
been
provided
with
the
health
care
provider
and
if
the
patient
and
the
health
care
provider
think
the
insurance
company
is
wrong.
I
believe
their
only
remedy
would
be
go
to
the
Nevada
commissure
of
insurance.
So
if
anything,
I
don't
think
this
is
one-sided
at
all.
I
think
it
protects
the
insurance
company.
C
The
ball
is
in
their
Court
as
to
whether
they
believe
adequate
justification
has
been
met
so
and
if
they
don't
and
if
I'm,
the
patient
who's,
not
getting
the
medication.
My
doctor
wants
me
to
get
my
only
remedy,
even
if
Senate
Bill
194
passes,
is
to
go
and
seek
help
from
the
commissioner
of
insurance,
which
we've
got
a
great
division
of
insurance,
great
Commissioner
of
Insurance,
but
that's
a
lengthy
process,
and
that
could
take
months
that
you're
not
getting
the
medication.
C
G
Thank
you,
Senator
orange
hall,
for
your
presentation
and
Hannah
and
Lucy.
Thank
you
for
being
here
and
sharing
your
stories.
I
greatly
appreciate
that
it
certainly
is
a
frustration
for
the
dispensing
end
of
this.
When
you
get
a
doctor
that
writes
a
prescription,
and
then
you
got
to
tell
the
patient,
this
is
not
covered
and
we
got
to
call
the
doctor
and
find
an
alternative,
and
the
doctor
says:
well,
let's
put
them
on
this
drug,
and
then
you
find
out
that
Drug's
not
covered.
G
G
Give
you
just
one
example
of
a
family
member
that
was
being
treated
for
depression
for
over
20
years,
and
it
was
on
a
generic
antidepressant
and
the
switch
insurance
companies
and
the
the
new
PBM
so
that
that
drug
was
no
longer
covered,
and
this
patient
had
already
my
family
member
had
already
tried
other
antidepressants.
It
was
already
a
generic
drug
to
keep
in
mind
and
they
said
they
would
not
cover
it.
So
we
had
to
go
through
the
appeal
process
which
took
about
a
month
and
a
half
the
person
was
paying
for.
G
My
relative
was
paying
for
the
medication
and
then
when
we
finally
got
the
approval,
the
insurance
company
wouldn't
allow
the
dose
that
the
doctor
was
ordering
for
the
drug.
So
we
had
to
go
through
this
whole
appeal
process
all
over
again.
So
is
there
a
need
for
a
streamlined
process
to
get
drugs
covered
for
patients?
Absolutely
yes,
and
so
I
think
your
bill
is
is
balanced
in
the
way
it
is
written.
G
You
know,
I
think.
One
way
that
might
alleviate
a
lot
of
these
issues
is
that
you
know
these
insurance
companies
through
the
pbms
publish
formularies
right.
G
Well,
I'll
I'll,
compare
that
to
when
you
go
to
a
restaurant
and
you
order
a
burrito
at
Del,
Taco
right
they're,
going
to
tell
you
that
if
we,
if
you
get
the
12
ounce
burrito
it's
going
to
be
800
calories.
If
you
get
the
six
ounce
burrito,
it's
going
to
be
500
calories.
I
personally
think
the
formulary
is
when
they
have
drugs
that
are
on
the
formulas.
G
They
should
be
put
a
range
of
costs
so
that
the
physician
can
see,
because
when
a
physician
is
prescribing
medications,
they're
they're,
getting
the
information
from
drug
detail,
people
and
what
are
they
coming
in
with
they're
coming
in
with
brand
name
drugs
right?
So
they
may
not
be
aware
that
there's
a
generic
available
for
a
drug
and
so
I
think
if
this
is
an
idea
for
a
future
bill
that
when
you
have
formulas
there
should
be
cost
ranges
on
these
drugs,
so
that
Physicians
can
say.
G
Well,
you
know
this
drug
is
a
thousand
dollars
a
month
and
this
other
drug
that
I
think
can
do
the
job
is
25
a
month.
Then
he
can
make
the
therapeutic
decision
whether
or
not
it's
worth
a
failure
for
for
the
patient
to
be
put
on
on
that
drug.
So
I
want
to
applaud
you
for
for
carefully
writing
this
and
I
love
the
idea
of
having
the
website,
but
we
also
know
that
we
live
in
a
technological
age
where
things
don't
always
work
as
well
as
we
want.
G
Technology
can
be
a
blessing
or
it
could
be
a
curse
right.
So
the
only
issue
that
I
have
with
the
belt
is
section
10
and
it
says
section
belt.
A
Texas
intent
of
this
bill
authorizes
a
Commissioner
of
Insurance
to
suspend
or
revoke
her
certificate
of
health
insurance
maintenance
organization
that
fails
to
comply.
G
G
If
you
don't
get
this
fixed
in
10
days,
your
license
is
in
Jeopardy
just
because,
if
you
just
revoke
an
insurance
company's
license,
you've
got
thousands
of
people,
they're
gonna,
where
am
I
going
to
go
for
my
health
insurance,
so
I
just
hope
that
you'll
maybe
be
a
little
more
sensitive
to
that,
and
if
it's
already
in
here
someplace
that
I
didn't
see
it.
Please
please
let
me
know.
C
Chair
Spearman,
with
your
permission,
James
orenshaw,
State,
Senate,
District,
21,
Senator
Sun.
Thank
you
for
your
comments.
I
appreciate
you
sharing
your
experiences
of
practicing
pharmacist.
Certainly
I've
got
relatives
with
serious
illnesses
and
I've
seen
situations
where
their
health
care
provider
has
said.
You
know
I
want
you
to
try
this
medication.
They
run
down
to
the
pharmacy
to
go
pick
up
that
medication
and
the
pharmacist
lets
them
know
Well.
C
So
certainly
there's
a
need
for
a
lot
of
Reform
there
and
it's
a
difficult
situation
and
I
think
this
bill
will
help
with
that.
As
to
your
question
regarding
section
10.,
that's
existing
law
regarding
Powers,
the
commissioner
of
insurance
has
and
I
don't
want
to
speak
for
the
commissioner,
I'm,
not
sure
if
they're
here
today,
past
experience
I've
had
with
family
members
and
with
constituents
when
there
were
issues
where
insurance
companies,
this
was
with
failing
to
cover
up
actually
a
surgery.
C
If
you
don't
do
what
we're
ordering
you
to
do
and
cover
this
was
the
big
stick
they
had
I
asked
how
often
this
is
actually
used
and
what
kind
of
steps
they
use
in
terms
of
progressive
discipline
with
insurers
who
are
not
complying
with
Nevada
law
that,
if
they're
here,
hopefully
they
can
speak
to
you
but
I
I,
believe
you
know
the
actual
revocation
of
someone's
license
rarely
happens,
but
I
believe
this
is
part
of
their
toolbox
in
terms
of
trying
to
make
sure
that
insurance
companies
comply
with
the
statutes
and
I.
Think
section.
G
And
I
really
appreciate
that
I
just
worry
that
when
you
have
technological
parameters
such
as
a
website
and
what,
if
the
website
is
down
or
what,
if
something's,
not
included
in
the
website,
inadvertently
an
honest
error.
I
just
don't
want
to
see
an
insurance
company
get
sanctioned
in
some
way
when
they
have
an
ability
to
remedy.
Once
it's
made
brought
to
their
attention.
That's
all
I'm
concerned
about
and.
C
James
orange
all
states
and
district
21
be
happy
to
talk
with
you
and
perhaps
there's
an
amendment
that
could
be
provided
to
look
at
more
Progressive
discipline
for
insurance
companies
under
the
commissioner
of
insurance
and
if
they're
here,
maybe
they
can
speak
to
what
happens
now
under
existing
law
when
there's
an
issue
with
an
insurer,
not
covering
something
that's
already
in
statute.
Thank
you.
A
H
Okay,
better
Mike's
success
this
time
around.
Thank
you,
chair.
Thank
you,
Senator
Orrin
Sean.
Thank
you.
So
much
for
sharing
your
very
brave
testimony
with
us
today.
I
had
a
question
more
with
how
the
practicalities
of
it
worked
and
I
was
just
hoping.
H
You
could
help
answer
a
question,
and
it's
section
one
number
two
c
and
it's
written
throughout
the
legislation,
essentially
that
the
insurer
has
72
hours
to
respond
to
the
request
or
24
hours
if
there
are
exigent
circumstances
and
just
because
we
apparently
this
legislation
has
happened
now
in
36,
States
I
was
more
just
curious.
If
that
was
happening,
how
that
process
was
working.
E
C
And
chair
with
your
President,
James
or
Charles
state
senator
District,
21.
I
was
actually
looking
over
the
Oklahoma
legislation
and
I
think
we're
actually
a
little
more
generous
here
in
this
bill,
because
I
think
the
Oklahoma
legislation
has
a
hard
24
hours
in
terms
of
getting
a
reply
from
the
insurance
company.
We
do
have
this.
You
know
24
up
to
72.
it's
trying
to
make
sure
that
patients
aren't.
You
know
languishing
waiting
like
the
example.
I
just
gave
Senator
stone
with
my
relative,
where
the
pharmacist
said.
C
No,
it's
fine
that
your
health
care
practitioner
wants
you
to
take
this,
but
until
I
hear
back
from
the
insurance
company-
and
sometimes
it's
been
weeks
until
they've
heard
back.
So
this
is
trying
to
make
sure
that
patients
aren't
languishing
waiting,
not
getting
the
medication
that
their
health
care
provider
believes
will
help
them
the
most.
H
Thank
you
and
to
be
clear,
I
absolutely
understand
the
need
for
that.
I
was
just
curious
if
it
was
actually
happening,
so
if
it
was
actually
working
so
that
patients
were
being
able
to
be
responded
to
within
that
time
frame,
because
I
do
think
it's
important
and
I
was
just
curious
since
it's
happening
in
36
other
states.
If
it
was
working.
C
Chair
James
or
Charles
State
Senate
District
21.
Certainly
what
I've
read
is
that
it
is
working
and
I
think
we're
going
to
have
some
testimony
from
some
healthcare
providers
who
work
not
only
in
Nevada
but
in
offices
in
other
states
who
can
also
discuss
as
to
how
it's
working
in
states
that
have
passed
similar
legislation.
But
what
I
read
is
that
it
is
working.
C
I
know
Hannah
and
Lucy
I'm
so
lucky
to
have
you
here.
Thank
you
for
sharing
the
struggles
you've
gone
through.
Thank
you,
chair
for
allowing
them
to
to
testify,
and
with
that
I
appreciate
your
hearing,
the
Bill
thank.
A
You
and
so
now
we
will
open
up
public
hearing
on
Senate
Bill
194.
Those
who
are
those
who
are
in
support.
Please
come
to
the
table
here.
There
are
three
chairs.
If
you
are
in
support
and
you
are
in
Las
Vegas,
please
come
to
the
table
and
think
there
are
two
chairs
there.
I
I
I
heard
this
gentleman
mention
the
senator
mentioned
800
for
a
prescription.
I
heard
the
next
Senator
mention
one
thousand
dollars
for
a
prescription.
I
have
never
seen
those
prices.
In
my
life,
the
drug
I'm
on
is
twenty
five
thousand
dollars
per
month.
The
insurance
company
either
covers
15
to
25
000
per
month
for
a
pill,
30
pills
with
a
certain
milligram
and
I.
I
I
You
know
pretty
much
tells
my
story
and
what
my
testimony
is
mostly
referring
to
is
in
Senate,
Bill
330,
which
I
know
is
not
today,
but
this
also
could
happen
to
me
because
there's
something
happening
now
with
multiple
sclerosis
drugs.
We
have
for
the
first
time
a
generic
it's
our
first
time.
I
I
The
AIDS
development
of
what
is
it
called
anyway,
beta
Saron
is
what
I
was
on
when
I
first
got
diagnosed,
if
it
wasn't
for
the
AIDS
research
and
them
using
that
drug
I
I
wouldn't
be
sitting
here
today.
Well,
I'd
be
sitting
in
a
wheelchair
today.
So
anyway,
since
1996
now
we're
all
the
way
to
a
pill,
they
never
ever
thought
they
could
get
a
pill
for
MS
when
I
was
first
diagnosed.
I
There
was
this
lady
sitting
in
the
same
room
as
me,
and
she
says
oh
I'm,
going
to
get
the
pill
and
I
thought
well,
who
the
hell
are
you
and
who's?
Your
insurance,
because
at
that
time
it
was
50
to
60
thousand
dollars
a
month
for
a
pill.
I
thought
she
thought
she
was
special,
but
now
all
these
years
later,
I'm
on
that
pill
and
I
think
I'm
special
too
I'm
lucky
to
be
on
that
drug.
Can
you
pour
me
some
water
Okay?
I
I
You're
going
to
note
that
I
was
very
sick.
Okay
after
I
got
that
sick.
They
had
to
put
me
on
a
stronger
drug
and
the
stronger
drug
was
an
infusion.
I
would
have
to
go
and
have
an
infusion
once
a
month
it
took
about
three
hours
and
that
was
like
50
to
60,
maybe
almost
to
80
000
a
month,
because
the
insurance
company
has
to
bill
for
the
infusion
center.
It's
not
just
the
drug
anymore,
so
we're
going
from
fifteen
thousand
to
fifty
to
sixty
thousand
per
month.
I
So
anyway,
I
reached
my
Peak
with
that
drug
when
you
measure
so
high
for
the
JC
virus
in
your
blood,
because
I
had
to
have
my
blood
taken
all
the
time
when
you
get
to
a
certain
point,
you
have
a
risk
of
what's
called
PML.
Pml
is
a
brain
disease
that
kills
you
you're
dead.
It's
the
end
of
it's
the
end
of
it,
so
I
registered
too
high
and
I
had
to
stop
that
drug.
That's
why
they
put
me
on
the
pill.
I
I
got
lucky
enough
to
get
to
that
tier,
so
I've
been
through
five
to
six
different
Ms
therapies.
If,
if
step
therapy
was
forced
on
me
with
my
new
insurance,
which
is
already
messing
with
me,
if
I
was
forced
to
go
on
to
step
therapy,
they
could
put
me
on
the
first
couple.
Drugs
I
already
been
through
with
Ms.
It
doesn't
work
that
way.
It
does
not.
Each
separate
Ms
drug
attacks,
a
different
part
of
your
body
and
I,
say
attacks,
because
that's
what
it
does.
I
It
has
to
shut
down
a
certain
part
of
your
immune
system.
That's
pretty
serious,
so
you
can't
just
be
bounced.
You
cannot
and
if
I'm
balanced
right
now
from
my
name
brand
abagio
if
I
get
bounced
to
the
first
ever
generic,
it's
a
generic
for
abagio.
Why
force
me
to
switch?
You
know
how
much
I
had
to
go
through
to
get
a
copay
card
so
that
I
could
actually
afford
my
drug.
If
I'm
bounce
to
the
generic,
where
does
my
copay
card
go?
It
disappears,
then
I
cannot
afford
my
drug.
I
I'm,
sorry,
but
we
could
talk
for
hours
about
how
how
serious
this
stuff
is.
Okay,
good
morning,
I
would
like
to
tell
you
what
medical
management
technique
means
to
me.
It
cost
me
my
job.
My
identity
gave
me
two
brain
lesions
and
took
the
feeling
in
my
arms
and
hands.
I
was
in
pain,
had
difficulty
thinking
could
I
could
not
write.
My
own
name
for
years
could
not
tie
my
shoes
or
button.
My
blouse
and
I
still
cannot
do
buttons.
I
My
husband
does
I
had
worked
for
the
state
of
Nevada
for
almost
17
years
when
suddenly,
as
a
cost-saving
measure,
the
Specialty
Pharmacy
contracted
by
the
state
of
Nevada
was
changed
to
a
new
Specialty
Pharmacy
as
a
medical
management
technique.
My
drug
for
multiple
sclerosis
was
withheld
from
me
for
almost
two
months,
I
contacted
the
governor,
my
elected
officials.
Anyone
and
everyone
I
could
try
and
help
me,
and
nobody
could
do
anything
to
help
me.
I
What
we
do
in
order
to
keep
people
well
and
on
medication
should
be
a
priority,
not
a
cost
savings
experiment.
Medical
management
techniques
are
a
sadistic
way
to
treat
your
fellow
nevadans
and
have
real-world
consequences.
As
my
story
can
tell
you,
please
fight
for
the
rights
of
me
and
others
who
need
honest,
accessible,
Health,
Care,
and
the
PS
on
my
statement
is
regarding
SB
194
step
therapy
protocol
is
another
sadistic
form
of
treatment
in
which
you're
letting
the
insurance
company
play
God
with
the
life
of
nevadans,
who
need
to
be
treated
the
way
their
trusted.
I
Doctors
had
intended
with
the
specific
drug
and
treatment
that
was
intended,
and
the
reason
why
I
use
the
word
sadistic
is
because
we
suffer
you
don't
know
how
much
I
suffered
when
my
drug
was
withheld
from
me.
I
would
be
out
there
in
the
parking
lot
every
day
from
my
job,
I
would
go
outside
and
I
would
try
and
call
somebody
to
help
me
and
I
would
stand
out
there
and
I
would
scream
and
I
would
cry.
K
Good
morning
my
name
is
Chris
knollert
and
I'm,
the
leader
of
the
MS
Invincible
support
group
and
I'm
reading
this
testimony
for
one
of
my
members
who
couldn't
be
here.
This
is
her
and
her
testimony
is
this.
My
name
is
Jan
clay,
I've
had
multiple
sclerosis
for
34
years
earlier
this
year,
I
was
also
treated
for
a
very
aggressive
esophageal
cancer
and
now
at
age,
70
I
also
have
rheumatoid
arthritis
that
is
Raging.
K
You
see,
I
understand
the
importance
of
this
bill
to
the
chronic
disease
patients
I
stopped
taking
my
original
Ms
drug
Copaxone,
because
my
insurance
took
it
off
the
formulary.
They
forced
me
to
try
and
fail
on
a
different
generic
drug,
which
my
body
could
not
tolerate.
Desperate
I
started
paying
eight
thousand
dollars
a
month
out
of
pocket.
I
filed
an
appeal
to
the
insurance
company
and
it
was
denied
lucky.
For
me,
one
of
my
ra
drugs
is
almost
the
same
as
another
Ms
modifying
drug
called
debaggio.
K
The
medication
my
rheumatologist
actually
wants
me
to
be
on
is
Orencia,
but
that
will
cost
me
twenty
four
hundred
dollars
a
month
at
my
infusion
center.
None
of
my
meds
are
what
is
best
for
me.
It
is
beyond
crazy
that
we
allow
this.
My
oncologist
is
working
with
me
to
figure
out
what
to
do.
Passing.
K
L
My
name
is
Vivian
Lao
and
I
have
been
a
multiple
sclerosis
patient
for
22
years.
I
have
more
than
one
story
a
year
about
these
kind
of
challenges
to
medication.
Pricing
I
want
you
all
to
look
at
your
exhibit.
This
is
when
I
was
diagnosed.
There
was
just
two
medications.
My
medication
was
7850,
something
dollars
billable
price
a
month
that
exact
same
medication
is
now
up
here
in
the
80
thousands.
L
L
The
irony
is
that,
as
the
range
of
medications
available
has
dramatically
improved
the
long-term
outcomes
and
delayed
disability,
look
at
us.
The
response
to
these
high
prices
has
been
to
limit
access
to
them
availing
themselves
of
every
excuse.
So
you
worry
about
the
insurance
companies
having
too
short
a
time
to
respond.
What
they
actually
do
is
give
us
the
run
around.
They
have
10
days
to
respond
and
then
10
days
work
build
working
days
to
respond
to
the
response.
L
One
of
my
last
challenges
that
was
just
so
frustrating
I.
My
doctor,
the
head
of
the
MS
Center
at
Stanford,
wanted
me
on
a
certain
dosing
schedule
as
similar
to
what
happened
to
Heidi,
because
my
medication
was
not
quite
doing
the
job.
I
was
getting
into
something
a
forgive
my
language
referred
to
as
the
crap
Gap,
where
you
can't
make
it
from
one
dose
to
another.
So
he
tried
to
adjust
my
dosage.
L
That
expert
was
used
as
a
justification
to
deny
the
head
of
Stanford
MS
Center,
who
who's
worked
on
this
disease
for
his
entire
life
and
override
the
the
decision
that
he
was
making.
For
me,
the
drug
I'm
currently
on
is
not
the
dog.
My
doctor
wanted
me
on
I
think
we
all
experiences
so
we're
being
managed
we're
not
asking
for
the
most
expensive
drug
we're
just
asking
for
the
drug.
That's
going
to
work,
do
not
repeat
drugs
that
we
already
know
are
going
to
fail
the
main
thrust
of
MS
research
for
the
last
20
years.
L
This
is
what
we've
concluded.
If
you
treat
early,
you
treat
aggressively
you
stabilize
a
patient.
The
outcome
looks
like
this.
If
you
give
Ms
a
chance,
it
pounces
and
then
what
happens
to
Heidi
happens.
What
happened
to
Jan
happen?
What
happened
to
all
the
women
happened,
so
we
should
be
managing
for
the
longer
term
outcomes,
and
yes,
that
includes
cost
too,
but
the
bills
for
our
catastrophic
situations
from
delay,
and
this
aggressive,
weaponized
pre-authorization
system
is
being
welded
against
patients
to
control
these
costs.
L
A
Thank
you,
we'll
go
down
to
Las,
Vegas
and
y'all
can
step
back.
If
there's
anyone
else
here
in
Carson
City
who
wants
to
testify
and
support.
A
M
N
Williams
I'm
president
of
Lupus
of
Nevada,
very
proud
to
be
I'm
here
and
asking
you
please
support.
194.,
please
I've
had
lupus
for
23
years,
I
started
lupus
with
being
blind
and
I
didn't.
Think.
I
was
ever
going
to
see
again
in
the
Bay
Area
and
my
Stanford
doctors
worked
hard
when
I
got
out
to
Las
Vegas
20
years
ago.
N
It
was
I
couldn't
find
anyone
to
help
me,
and
it
was
just
by
the
grace
of
God
I.
There
are
a
few
good
doctors
there
and
we
Loop
this
individuals
started
working
together
and
started
wanting
to
do
something
together
and
fight
for
what
we
need
to
fight
for,
and
this
is
so
important
for
us
to
do
this
fight
and
not
watch.
N
One
of
them
had
authorized
a
drug
for
me,
so
what
happened
was
the
insurance
company
said?
Well
we're
not
going
to
give
her
that
you
know
we're
going
to
give
her
something
else,
and
my
doctor
called
back
and
said
she
will
get
the
drug
she
needs
I'm,
not
playing
with
you
insurance
companies.
This
woman
has
major
problems
and
it
will
be
what
it's
be.
N
A
O
Good
morning,
Madam
chair
members
of
the
commit
senate
committee
on
Commerce
and
labor
Brian
Walker
senior,
vice
president
of
the
retail
association
of
Nevada,
on
behalf
of
our
our
Pharmacy
members.
We
are
in
agreement
in
support
of
sb194,
often
times
we
are
the
front
lines.
It's
our
employees
that
have
to
deal
with
the
frustration
of
patients
who
who
are
trying
to
navigate
a
very
complicated
system,
and
it's
frustrating
to
be
able
to
have
a
medication
that
we
know
will
probably
work
better.
O
P
Good
morning,
chair
spearmen
and
members
of
the
committee
for
the
record
Carrie
Harrington
I'm,
the
executive
director
with
Nevada
cancer
Coalition,
we're
very
grateful
that
Senator
Lang
addressed
this
for
our
stage
for
cancer
patients.
We
would
love
to
increase
this
to
cover
anyone
with
cancer
at
any
stage
cancer.
Now
with
today's
technology,
and
the
advances
in
care
is
very
individualized
as
far
as
treatment.
No
one's
cancer
is
exactly
the
same
as
another's
so
failing.
First
on
a
medication
or
treatment
for
anyone
with
cancer
could
mean
life
or
death
at
any
stage.
P
Q
Oh
hello,
good
morning,
Madam
chair
members
of
the
committee
for
the
record.
My
name
is
Sean.
Navarro
I
live
in
Senate
District
Six
I'm
here
to
testify
in
favor
of
this
bill.
Q
Yeah
I
want
to
really
thank
everyone
for
the
testimony
and
the
witnesses
that
we've
seen
already
I
think
this
makes
it
very
clear
that
these
people
are
more
than
claims
or
more
than
names,
on
spreadsheets,
these
giant
insurance
companies,
they're
they're
people
with
real
stories
or
real
families,
and
they
fix
not
just
the
people
directly,
but
their
families
as
well.
I
know
for
me
personally.
I
was
unexpectedly
hospitalized
this
past
January
for
two
weeks
with
emergency,
gallbladder
surgery
and
I
kind
of
learned
about
how
our
current
medical
system
works.
Q
Where
you
need
someone
to
advocate
for
you
or
you
have
to
learn
to
advocate
for
yourself
and
a
lot
of
folks,
don't
have
that
many
folks
in
the
Latino
community
and
immigrant
communities
they
they
find
it
very
difficult
to
navigate
this
very
Byzantine
system
we
currently
have
between
doctors
and
and
pharmacists
insurance
companies,
so
I
think
anything
that
helps
streamline
the
process
is
very
good.
So
I
want
to
thank
you
all
so
much
for
your
time
and
I
hope
you
support
this
bill
thanks.
So
much.
R
Thank
you
good
morning,
Sean
McCoy
from
Reno
Nevada
I'm
here
on
behalf
of
my
family.
Fortunately,
we
didn't
have
to
fail.
First,
we
were
diagnosed
with
crohn's
and
were
able
to
get
on
Stelara
right
away.
The
concern
we
have
is
that
we
had
to
stay
on
COBRA
to
make
sure
Insurance
did
not
change,
because
any
change
was
going
to
potentially
require
us
to
go
back
and
look
at
failing.
R
S
Patrick
Frazee
I'm
from
Las,
Vegas
and
I
want
to
thank
you
for
supporting
this
bill.
I
am
here
today
representing
the
the
national
psoriasis
foundation
with
Lucy,
who
is
just
here.
I
am
the
the
lone
Advocate
volunteer
for
Las
Vegas
and
the
state
of
Nevada
for
the
psoriasis
Foundation.
Nobody
else
is
doing
this
as
a
volunteer
and
I'm
so
glad
to
be
here,
because
there's
30
some
odd
autoimmune
diseases
and
they're
all
represented
here
today
and
I
myself
also
am
a
psoriasis
patient,
but
I
have
been
blessed.
S
I
did
seven
years
of
clinical
trials
as
an
official
guinea
pig
and
so
I
did
the
step
therapy
within
my
clinical
trials.
I
am
now
on
the
farm
that
actually
I
went
through
three
different
Pharmaceuticals,
who
are
all
now
available
on
the
market,
humerus
stelera
and
there's
another
one
I'm
now
on
from
fire,
which
I
was
clinically
on
for
a
while,
it
has
worked
for
me.
I
am
blessed
right
now.
My
out
of
pocket
is
zero
per
month,
but
that's
going
to
change,
I
think
so.
S
I'm
not
trying
to
break
here
I'm
trying
to
be
honest
and
say
that
I'm
here
to
help
whatever
has
to
be
done.
I'm
representing
Las
Vegas
I'm,
representing
the
state
of
Nevada
as
an
advocate
volunteer
you'll,
see
me
again
in
fact
I'm
coming
back
up
here
in
another
couple
weeks
for
another
medical
organization
to
do
this
again,
so
I'm
serious
about
this
and
I.
Thank
you
all
so
much
for
giving
us
this
time
today
in
in
the
the
capital
here
to
help
us
support
this
cause.
Thank
you.
So
much.
U
Afternoon
share
Spearman
and
members
of
the
committee
for
the
record.
My
name
is
Aaron
Rook,
that's
e-r-I-n-r-o-o-k
I
live
in
Senate
District,
three
and
I'm
here
to
testify
and
support
Senate
bill
194.
as
someone
living
with
multiple
chronic
illnesses,
I've
also
experienced
unnecessary
delays
and
accessing
doctor
prescribed
treatments
due
to
step
therapy
protocols.
I
primarily
had
this
experience
in
relation
to
medication
for
ADHD
the
step
therapy
protocols
meant
that
I
had
to
try
multiple,
less
expensive
medications.
Before
my
insurance
would
approve
the
prescription.
My
provider
knew
would
be
most
effective
during
that
time.
U
I
not
only
wiped
out
symptom
relief,
I
also
experienced
challenging
side
effects.
It
was
rough,
but
what
I
really
worry
about
is
facing
this
battle
over
my
mom's
serious
health
conditions
like
the
earlier
presenters
I
also
have
a
type
of
inflammatory
bowel
disease
called
ulcerative.
Colitis
I
also
have
a
chronic
aluminum
condition
called
heterogeneity
suprativa,
for
which
the
primary
treatment
is
a
biologic
I've
been
lucky
to
not
yet
require
medications
that
require
that
prior
authorization
I
expected.
This
will
be
part
of
my
future.
U
As
many
folks
have
said,
I
think
it's
really
important
for
people
to
realize
that
these
types
of
diseases
can
a
seriously
even
fatal
outcomes
if
not
properly
treated,
whereas
the
worst
case
outcome
for
insurance
providers
is
a
decrease
in
profits.
To
illustrate
at
a
recent
visit
with
my
GI
doctor,
after
a
period
of
being
off
medication
due
to
lack
of
insurance,
she
told
me
that
I
was
playing
with
fire
and
that
I
increased
my
risk
of
colon
cancer.
U
Every
day,
I
went
without
taking
my
maintenance
medication
patients
already
experience
enough
that
barriers
to
accessing
care,
the
least
we
could
do
is
make
it
easier
to
access
the
medication
the
doctor
prescribed.
This
is
an
issue
that
has
impacts
my
husband
as
well.
Who's
rheumatoid
arthritis
requires
both
expensive
biologic
medications
and
without
which
he's
not
able
to
work
or
even
do
something
as
simple
as
open.
A
doorknob
I
urge
you
to
support
Senate
Bill
194
to
help
ensure
that
patients
have
the
ability
to
access
appropriate,
Medical
Care
without
children
groups.
Thank
you.
A
Thank
you
now
we'll
open
up
public
testimony
for
those
in
opposition
here
in
Carson
City
in
Las,
Vegas.
V
Thank
you,
chair
Paul
Young,
with
Tom
Clark
Solutions
on
behalf
of
pharmaceutical
care.
Man's
Association
keep
it
short
we'd
like
to
thank
Senator
orange
Shaw
for
bringing
this
important
bill.
We
do
understand
the
concerns
of
everyone
and
even
though,
unfortunately,
at
this
time,
we're
opposed
sb194
in
its
current
form.
We
look
forward
to
working
with
Senator
on
this
bill
and
getting
to
a
place.
Thank
you.
A
You
anyone
here
in
Carson,
City
or
in
Las
Vegas
in
neutral.
W
Morning,
chair
members
of
the
committee,
my
name
is
Carrie
Eaton
I
am
the
Chief
Financial
Officer
for
the
public
employees
benefits
program.
The
pet
board
has
reviewed
this
bill
and
has
voted
to
take
a
neutral
stance.
Step
therapy
is
a
common
cost
control
measure
used
by
insurance
plans,
including
PEB,
to
steer
patients
to
medically
equivalent
yet
cause
get
less
costly
drugs
before
moving
to
her
cause
drug.
W
W
Although
this
bill
establishes
an
appeal
process
which
pebb
already
has
in
place,
the
final
say
ultimately
lands
on
the
provider,
which
is
projected
to
reduce
the
volume
of
Step
therapy
cases
significantly
likely
up
to
40
percent.
This
is
anticipated
to
drive
concept
by
a
projected
1.5
million
dollars
per
year
to
pep.
A
Think
it
was
the
average
age
of
your
beneficiaries.
Do
you
know.
W
I
do
not
know
that
I
can
get
that
to
the
committee.
A
A
Thank
you.
I
just
want
to
ask
our
legal
counsel
who
who
who
would
be
affected
if
this
bill
were
to
pass,
is
that
Arizona
public
plans
or
who,
who
is
affected.
X
Thank
you.
This
bill
would
apply
only
to
private
insurers,
the
so
it
would
not
apply
to
PEB
or
to
local
governments,
and
that
is
because
NRS
287.04335
sets
forth
the
provisions
of
the
insurance
laws
that
require
coverage.
It
says
forth
which
sections
apply
to
PEB,
and
this
bill
does
not
amend
that
section
to
include
these
this,
these
Provisions
as
applicable
to
PEB.
Also
it
would
this
bill
would
not
affect
erisa
plans.
X
No,
the
section
12
of
the
bill
provides
that
the
provisions
of
section
11,
which
is
the
Medicaid
Managed
Care
or
the
sorry.
The
provisions
of
section
12,
specifies
that
section
11,
which
is
the
provisions
applicable
to
manage
Care
organizations,
do
not
apply
to
Health
Care
Services
Healthcare
Services
to
recipients
of
Medicaid.
So
it
is
private
insurers.
C
C
I
want
to
thank
Hannah
and
Lucy
for
sharing
the
brave
struggles
they
went
through
and
everyone
else
who
testified.
Thank
you,
chair
and
members
for
hearing
the
committee
I
believe
Senate
Bill
194
would
help
protect
our
constituents
and
I
believe
that
it
is
written
in
a
way
where
those
two
words
adequate
justification
would
would
be
in
the
insurance
Court
to
decide
whether
adequate
justification
has
been
met
for
that
exemption
from
Step
therapy.
This
bill
does
not
abolish
that
therapy
provides
a
process
for
an
exemption
and
an
appeal
and
I
believe.
C
If
that
were
denied,
then
our
constituents,
who
are
you
know,
hoping
to
try
that
medication
that
the
doctor
wants
them
to
get
or
the
healthcare
provider
wants
them
to
get.
Then
they'd
have
to
go
to
the
Commissioner
of
Insurance
I
believe
the
bear.
The
bill
really
does
look
at
both
sides
trying
to
protect
the
patient.
Trying
to
protect
the
insurance
company,
I'm,
certainly
open
to
amendments
to
try
to
expand
it.
C
The
bill
now,
I,
don't
believe,
covers
the
public
employees
benefit
program,
so
I
think
there's
a
fiscal
note
that
was
placed
on
the
bill
for
three
million
dollars,
but
I
think
that's
an
error,
so
I
don't
believe
this
is
the
bill
does
not
cover
the
public
employees
benefit
program.
I'd
hope
that
fiscal
note
would
be
removed
and
I'm
looking
forward
to
working
with
all
parties.
I
appreciate,
Mr,
Young
who's
reached
out
to
me,
and
you
know
trying
to
reach
out
to
other
other
concerned
parties.
C
E
Lucy
lab
National
psoriasis
Foundation
as
far
as
erisa
plans
go.
There
is
the
safe
step
act
currently
in
the
in
the
U.S
Congress
right
now
in
the
in
the
Senate.
We
do
have
support
from
Senators
Rosen
and
Cortez
masto
on
that
as
well.
E
So
we
are
trying
to
tackle
this
from
both
sides,
the
state
level
and
the
federal
level,
and
then
in
conclusion,
I
just
really
want
the
committee
and
whoever's
listening
to
really
understand
what
it
means
to
fail:
a
medication,
what
it
means
to
be
sick
as
a
person
with
a
chronic
illness.
E
It's
not
just
having
a
cold
or
feeling
under
the
weather
or
missing
a
couple
days
off
of
work.
Failing
a
medication
can
mean
hospitalizations,
it
can
mean
procedures.
It
can
mean
a
lot
of
pain,
missing
long
periods
of
school
or
work,
and
it
can
mean
irreversible
effects.
E
It's
it's
really
challenging
living
with
a
chronic
illness,
and
that
impacts
you
in
every
aspect
of
life
financially
emotionally
physically
and
to
be
going
through.
All
of
that,
while
you
know
there's
a
medication
out
there,
that
will
work
for
you
adds
to
the
suffering
so
I
I,
just
I,
really
want
you
all
to
to
sit
with
that
and
understand
what
it
means
to
be
a
person
with
a
chronic
illness
and
why?
Why
is
that?
The
the
price
to
pay
for
insurance
companies
to
reduce
costs.
D
D
My
entire
body
has
been
racked
by
this
disease,
and
that's
largely
due
to
the
length
of
time
that
it
took
for
me
to
get
the
adequate
care.
I
have
pinched
nerves
in
my
shoulders
from
hunching
over
from
stomach
pain,
I
have
chronic
joint
pain.
D
Step
therapy
really
does
do
a
lot
of
damage
because
it
means
that
it's
months
or
even
years
in
which
you
are
not
getting,
that
adequate
care,
so
I
think
it's
just
really
important
to
note
the
effect
that
it
has
on
real
people
and
constituents.
Thank
you.
A
Thank
you,
yeah
I
have
a
sister
who
was
diagnosed
in
I,
think
was
1995
with
MS,
and
we
thank
God
every
day
that
my
brother-in-law
was
in
the
military
and
I.
A
That
one
of
the
best
decisions
I
made
in
78
was
to
get
commissioned,
so
I
do
understand.
I
have
a
sister
who
was
on
step
therapy
and
it
made
her
much
worse,
one
of
the
one
of
the
medications
that
they
gave
her.
She
dropped
like
40
pounds
in
two
months.
C
Chair
Spearman
James
or
Charles
State
Senate,
District
21,
that's
from
the
public
employees
benefit
program,
but
this
bill
does
not
open
chapter
287.
I.
Don't
believe
that
that
fiscal
note
I
think
that's
placed
an
error
so
hopefully
that'll
be
removed.
Thank
you
again
for
hearing
the
bill
and
thank
you,
members
for
your
attention
and
I
appreciate
your
consideration
of
this
bill.
Okay,.
A
Yeah
so
I
need
you
all,
perhaps
get
with
Senator
Orange
Show
and
make
sure
that
your
your
members,
whoever
made
the
decision
to
put
the
fiscal
note
on
to
make
sure
that
their
understanding
is
clear.
Whenever
there's
a
question
about
the
legality
of
anything,
we
always
defer
to
LCB.
A
They
are
our
Arbiter,
because
if
we
do
something
that
is
an
error
they're,
the
ones
that
have
to
defend
it
in
court,
so
make
sure
you
all
get
with
Senator
ornshaw
to
clear
that
up
and
make
sure
everybody
understands
what
the
law
says
with
respect
to
peps
and
I'll
just
end
with
this
I
think
it
was
Dr,
Angelo,
Maya
Angelou,
who
said
we
all
have
empathy.
The
question
is:
do
we
all
have
the
courage
to
display
it
so.
A
A
A
Z
Well,
good
morning,
chair,
Spearman
I
would
appear
in
front
of
your
anytime.
My
name
is
Melanie
scheible
I'm,
the
state
senator
for
district
9.
I
am
pleased
to
be
before
the
Senate,
Commerce
and
labor
committee
again
this
morning
with
my
colleague
Senator
Stone,
who
will
be
presenting
the
bill
and
walking
through
the
provisions
of
it,
as
well
as
a
conceptual
Amendment
with
you
and
before
he
does.
That
I
just
wanted
to
make
sure
that
you
all
understood
some
of
the
context
and
history
of
this
bill
here
in
the
state
of
Nevada.
Z
We
have
been
working
for
a
long
time
on
ensuring
that
everybody
has
adequate
access
to
necessary
health
care,
including
contraceptives,
starting
in
2017,
when
this
body
chose
to
pass
a
law
that
required
that
insurance
companies
covered
12
months
of
a
of
a
contraceptive
prescription
continuing
into
2019,
when
we
passed
another
law
to
ensure
that
that
contraceptives
would
be
available,
wait,
what
was
hold
on
I've
got
my
history
backwards.
Z
That's
why
I
brought
my
computer
okay.
First
in
in
2017,
we
required
that
insurance
companies
cover
a
12-month
prescription
for
a
contraceptive
in
2019.
We
required
that
that
contraceptive
be
made
available
over
the
counter
and
in
2021
we
required
that
that
over-the-counter
provision
remain,
in
effect,
I
may
have
said
that
a
little
bit
wrong,
but
my
point
is
that
the
law
already
requires
that
anybody
wishing
to
receive
a
birth
control
prescription
in
the
state
of
Nevada
be
able
to
get
one
for
12
full
months
on
their
insurance
plan.
Z
Z
Other
folks
who
require
you
know,
hormonal
contraceptives
wouldn't
have
to
make
multiple
appointments
with
their
doctor
or
their
pa
or
another
provider,
and
have
to
go
to
multiple
appointments
for
what
is,
in
most
cases,
a
very
simple
process,
certainly
for
some
people
finding
the
right
birth
control
can
be
more
complicated,
but
for
many
of
us
it's
as
simple
as
getting
one
prescription
for
one
pill
or
a
ring
or
a
patch,
and
once
we
find
the
one
that
we
like.
Z
We
keep
renewing
that
prescription
for
years
and
even
decades,
and
so
for
all
of
those
cases.
We
have
already
tried,
in
the
state
of
Nevada,
to
create
system
where
you,
you
find
your
birth
control,
and
then
you
can
be
prescribed
that
birth
control
for
a
full
12
months
go
to
the
pharmacy
and
get
that
12-month
Supply.
Z
We
had
included
a
provision
allowing
for
the
first
prescription
Duty
only
three
months,
long
and
then
12
months
after
that,
and
when
people
were
switching
Insurance,
the
insurance
companies
were
going
back
and
starting
over
with
that
three-month
prescription
or
the
pbms
were
simply
interpreting
the
law
in
a
different
way
and
and
not
allowing
pharmacists
to
fill
those
prescriptions
for
the
full
12
months.
Z
So
that
is
why
we
are
bringing
SB
352
to
you
today
to
close
the
loopholes
clean
up
the
language,
ensure
that
every
person
in
Nevada
can
go
to
their
pharmacist,
be
prescribed,
12
months
of
contraception
and
receive
all
12
months
at
one
time,
and
I
will
now
turn
it
over
to
my
colleague,
who
will
explain
the
the
way
the
bill
does
that
much
better
than
I
could.
G
Thank
you,
Senator
scheibel,
Madam,
chair,
Spearman,
Vice,
chair
Lang.
It's
an
honor
to
be
presenting
before
you
all
here
today
and
I'm,
very
honored
and
humbled
that
my
colleague
Senator
scheibel,
allowed
me
to
partner
with
her
on
this
very
important
bill.
This
bill
will
expand
access
to
a
the
number
of
providers
that
can
provide
oral
contraceptive
to
patients
by
authorizing
pharmacists.
To
make
such
orders
it
further
codifies
the
responsibilities
of
a
pharmacy
benefit
manager,
commonly
known
as
pbms,
must
comply
with
the
same
provisions
of
the
Nevada
Insurance
code.
As
insurers
do.
G
Furthermore,
this
bill
will
not
let
insurers
or
the
pbms
they
contract
with
require
profit
prior
authorization
because
you
can
legally
get
these
and
you
shouldn't
have
to
have
any
steps
that
you
have
to
go
through
that
are
delays
in
getting
these,
especially
for
emergency
contraception,
which
we'll
get
into
in
a
little
bit
later.
And
finally,
this
bill
requires
Medicaid
and
private
insurers
that
are
Contracting
with
pbms
to
allow
the
dispensing
up
to
a
12-month
supply
of
the
oral
contraceptives.
G
So,
as
we've
all
heard,
we
have
a
a
shortage
of
primary
care
providers
here
in
Nevada,
especially
in
the
rural
areas.
This
is
going
to
expand
access
to
oral
contraceptives,
including
emergency
contraceptives,
24
hours
a
day,
seven
days
a
week
that
a
patient
can't
typically
get
by
going
to
a
physician
or
nurse
practitioner
or
a
physician
assistant.
So
this
is
going
to
expand
accessibility.
G
So
if
I
can
I'd
like
to
just
briefly
go
over
what
the
build
does-
and
you
do
have
some
amendments
which
I
hope
you
have
copies
of,
because
I
will
be
referring
to
those
so
section,
A
Pharmacy
benefits
manager
that
manages
prescription
benefits
for
an
insurer
is
required
to
comply
with
the
same
provisions
of
the
Nevada
Insurance
code.
As
is
applicable
to
the
insurer,
in
other
words,
they're
held
to
the
same
standard
as
insurers
and
following
through
and
making
sure
the
patients
get
the
medications
they
need.
For
section.
G
Two
I'd
like
to
refer
to
the
amendment
for
section
one.
A
health
care
carrier
shall
demonstrate
the
capacity
to
adequately
deliver
Family
Planning
Services,
provided
by
pharmacists
to
cover
persons,
in
accordance
with
the
regulations
adopted
persuading
to
subsection
two
by
giving
the
insured
notice
of
the
network
of
participating,
pharmacists
or
network
of
pharmacies
employing
such
pharmacists
that
are
contracted
to
the
prescriber,
to
prescribe
or
order
and
or
fill
such
prescriptions.
G
And
then,
in
section
three,
the
commissioner
shill
adopt
regulations
to
carry
out
the
provisions
of
this
section,
including
without
limitation
regulations
prescribing
requirements
for
a
health
carrier
to
demonstrate
compliance
with
subsection
one.
It
goes
on
to
say
those
regulations
must
not
allow
Health
Care
carrier
to
demonstrate
the
capacity
to
adequately
deliver
Family
Planning
services
to
covered
persons
by
demonstrating
that
the
health
carrier
has
entered
into
a
network
contract
with
one
or
more
pharmacies
for
the
sole
purpose
of
dispensing
drugs
to
covered
persons.
G
In
other
words,
the
insurance
company
will
need
to
let
the
the
patients
know
where
they
can
go
to
a
pharmacy.
That
just
doesn't
dispense,
but
you
have
a
pharmacist
couldn't
write
the
order
for
the
contraceptives,
whether
it's
for
their
everyday
contraceptives
or
an
emergency
contraceptive
in
case
a
condom
fails
a
patient
can
go
to
a
pharmacy
at
three
in
the
morning
and
say
I
need
some
emergency
contraceptive
to
prevent
a
pregnancy,
and
the
pharmacist
would
be
authorized
to
do
so.
G
So
this
is
like
getting
a
refill,
so
it
dispenses
a
12-month
supply
of
a
drug
or
therapeutic
equivalent,
again,
meaning
a
generic
for
a
drug
or
or
therapeutic
equivalent
for
the
same
drug
or
therapeutic
equivalent
that
a
patient
is
presently
using
for
contraception.
In
other
words,
they
get
a
12
month.
Supply
if
they
go
there,
January
1st
they
get
12
months
or
any
amount
designated
by
the
prescription
or
order
not
exceeding
12
months
or
any
amount
which
covers
the
remainder
of
a
plan
year.
G
If
a
patient
is
covered
by
a
health
care
plan,
whichevers
less,
we
all
know
we
we
file
for
new
insurance,
every
November,
usually
October
open
enrollment.
So
if
somebody
were
getting
a
prescription
in
June,
the
insurance
company
required
with
a
12-month
prescription
to
at
least
give
six
months
until
the
new
year
comes
around
section.
G
B
is
really
referring
to
patients
that
are
newly
being
prescribed
oral
contraceptives
and
we
wanted
to
limit
that
to
a
three-month
Supply,
because
what,
if
there's
a
side
effect
to
the
medication,
we
don't
want
the
insurance
company
to
pay
for
nine
more.
You
know
nine
months
of
medication,
that's
basically
going
to
be
thrown
in
the
RX
bins
that
I
hope
you'll
pass
through
another
piece
of
legislation
and
not
not
be
put
into.
A
G
Be
a
waste
so
so
I'll
read
B
again
dispense
a
three-month
supply
of
drug
or
therapy
to
equivalent
for
a
new
drug
or
therapy
to
equivalent
for
contraception.
Should
the
patient
be
maintained
on
the
new
drug
or
therapeutic
equivalent
beyond
the
first
three
months,
in
conformance
with
a
valid
prescription
or
order,
the
pharmacist
shall
dispense
then
a
nine
month
supply
of
the
drug
or
therapeutic
agent
or
any
amount
designated
by
the
practitioner
order
not
exceeding
a
nine
month,
supplier
order
or
any
amount
which
covers
a
remainder
of
the
plan
year.
G
If
the
patient
is
covered
by
the
health
care
plan,
which
is
less
and
wherein
any
co-pay
charge
to
the
patient
is
either
waived
or
prorated
based
on
what
a
12-month
prescription
would
have
cost.
In
other
words,
the
patient
is
taking
a
three
month
supply
to
make
sure
that
they
can
tolerate
it
and
it's
working
fine.
They
shouldn't
be
penalized
to
have
to
pay
another
co-pay
yet
again
to
get
the
remaining
nine
months
of
the
prescription.
G
A
Saying
I'm.
AA
Thank
you.
Thank
you,
chair
Spearman,
the
easier
we
can
make
access
to
contraceptive
the
better
hand
them
out
everywhere.
If
a
contraceptive
is
successful
for
a
year,
is
there
a
way
that
a
patient
can
just
have
the
doctor
call
in
a
renewal
or
do
they
have
to
actually
go
to
a
visit
with
their
doctor.
G
Well,
of
course,
we
always
encourage
a
patient
to
always
confer
with
their
doctors,
but
they
don't
need
to.
They
can
actually
just
go
to
the
pharmacy
and
the
pharmacist
can
authorize
a
12-month
Supply
January
1st
and
that's
that's.
The
beauty
of
this
legislation
is
if
they
don't
have
to
make
an
appointment
with
the
doctor,
they
can
get
it
24
7.
G
AA
G
F
F
You
they
want
to
be
in
a
network,
it
says
above
that's
demonstrating
this
and
then
it
almost
so
I
I
just
need
further
explanation,
because
I
know,
there's
a
point
and
I
know
you're
trying
to
fix
something.
I
just
wanted
to
have.
It
explained
a
little
bit.
Z
Melanie
scheibel
for
the
record,
at
the
risk
of
being
corrected
on
the
record.
I
had
the
same
question
and
so
I'm
going
to
see
if
by
explaining
how
I
understood
it
answers
it
the
same
way.
Basically,
the
health,
the
commissioner
is
going
to
set
those
rules.
That
says
you
have
to
prove
to
us
that
you
are
adequately
covering
people
and
what
that
last
sentence
says.
Is
that
the
you
have
to
show
that
the
pharmacies
are
not
just
for
dispensing
the
drugs,
but
that
you're
also
Contracting
with
pharmacists,
who
can
prescribe
the
drugs.
G
Senator
explain
that
perfectly
so,
when
you
get
your
annual
packet
from
your
insurance
company
they're
going
to
show
you
which
pharmacies
are
covered
by
your
respective
plans,
and
so
this
bill
is,
is
going
to
require
that
the
health
care
plans
demonstrate
to
you
which
pharmacies
can
prescribe
via
their
pharmacist
and
can
dispense
rather
than
a
a
plan.
Just
saying
these
are
the
pharmacies
that
you
can
go
to
without
delineating
that
they
only
dispense
and
they
don't
have
a
pharmacist
that
could
prescribe.
F
Okay
and
thank
you
that
that
does
answer
answer
the
question
on
that.
F
So
my
second
question:
it
was
in
I
think
it's
in
section
six
sub
2B
and
it
might
be
throughout
another
areas
as
well,
where
it
says
that
and
I
understand
when
the
network
contracts
with
the
pharmacist,
who
can
just
write
the
prescription,
that
it
can't
be
less
than
what
they
would
pay
a
physician
or
an
APRN,
et
cetera,
et
cetera.
F
J
F
Understand
the
protection
you're
trying
to
get
there
is
that
you
can't
force
them
say
well
we're
only
going
to
contract
with
you.
If
you
do
give
us
less,
but
would
they
be
able
to
agree
to
whatever
contract
they
wanted
to
make.
A
G
I'm
sorry,
Senator,
gemstone,
District,
20.,
I,
think
section.
Six
is
just
clarifying
that
a
pharmacist
provider
of
a
prescription
for
a
oral
contraceptive
or
an
emergency
contraceptive
shall
be
paid
at
the
same
reimbursement.
If
you
will,
if
a
physician,
we're
providing
the
same
service,
a
nurse
practitioner
or
a
physician
assistant.
Z
Melanie
scheibel
for
the
record,
if
I
could
also
add
that
when
we
learned
that
people
were
not
able
to
access
their
12-month
prescription,
we
I
say
we.
You
know
the
organizations
that
I've
partnered
with
on
this
did
some
research
into.
Why
interviewing
patients,
pharmacists,
insurers
and
found
that
pay
parity
was
actually
one
of
the
issues
that
was
standing
in
the
way.
So
from
a
a
realistic
perspective
that
was
not
happening.
F
And
and
I'm
sure
it's
not
a
big
issue
on
on
in
the
whole
scheme
of
things,
it's
probably
not
not
the
biggest
issue.
I
have
one
final
question,
based
on
your
amendment
that
you
asked
about
waiving
the
the
co-pay
I'm
assuming
that's.
If
the
person
got
the
three
months
that
you
know,
the
copay
was
only
for
a
three-month
Supply
I,
wouldn't
assume
they'd
charge
a
copay
for
the
whole
12
months,
so
when
they
went
back
and
got
the
other
nine
months
or
they
continued
on.
F
If
there
was
only
a
copay
for
that
second
nine
months,
they
could
still
have
to
co-pay
for
that
they
wouldn't
have
to
waive
it.
Is
that
your
intent
so.
G
Because
insure
I'm,
sorry
Senator
just
on
District
24
for
the
record,
the
the
purpose
of
what
I'm
trying
to
get
accomplished
here
is
that
insurance
companies
will
charge
co-pays
in
a
different
manner.
Sometimes
they
will
charge
a
copay
for
one
inclusive.
Prescription
assemble
charge
a
copay
for
every
month
that
the
birth
control
is
given.
G
So
if
they
charge
one
copay
and
the
person
is
getting
three
months
to
basically
save
the
insurance
company
nine
months
worth
of
contraceptives
that
the
person's
not
going
to
use
if
they
have
an
adverse
reaction,
they
shouldn't
be
penalized
for
getting
the
second
nine
months
that
they're
doing
fine
on
the
medication.
They've
helped
the
insurance
company
out.
F
And
and
thank
you
and
I
and
I
understand
I
know,
plan
design,
I'm
most
familiar
with
you,
you
pay
at
the
point
of
transaction
and
then
you
submit
whatever
it
is
amount
you
paid
to
get
reimbursed
minus
the
copay.
So
in
that
scenario,
they're
not
going
to
get
charged
for
the
other
nine
months
because
they
only
bought
the
three
were
paid
for
the
three.
So
so
I
understand
the
plan
design
on
other
ones,
though
too,
where
they
say
it
doesn't
matter
what
it
is.
F
You
have
a
25
copay
or
a
15
depending
on
where
it
is
in
the
formulary
and
every
time
they
go
in
they
get
charged
at
so
I.
If
they've
got
the
12
months,
they'd
got
that
one
and.
A
G
Senator
Jeff
Stone
District
24
for
the
record,
the
the
patient.
Obviously,
if
they're
having
an
adverse
reaction
to
the
oral
contraceptive,
would
I'm
sure
cease
to
take
it
and
they
would
seek
out
the
consultation
of
their
pharmacist
or
their
physician
to
rewrite
a
prescription.
And
then
we
get
another
three
three-month
supply
of
a
new
medication.
Hopefully
we'll
leave
you
those
side
effects
and
they
would
have
to
pay
the
co-pay
again,
unfortunately,
for
that
three
months,
so.
A
G
Well,
the
pharmaceutical
company
is
selling
they're
getting
their
money
for
the
for
the
for
the
drugs.
The
insurance
company,
unfortunately,
will
not
be
able
to
get
the
drug
taken
back
and
redispense
that's
against
federal
laws,
so
there
what
basically
will
be
a
loss
because
they're
going
to
have
to
duplicate
an
order
through
another
three
month,
supply
of
another
medication
to
make
sure
the
patient
can
tolerate
it.
G
R
A
So
you
indicated
that
the
contraceptive
medicine
and
if
a
condom
fails
then
there's
some
steps
that
the
person
can
do
so
there
has
been
a
shall
I,
say
discussion
in
this
country
about
people
who
have
certain
religious
beliefs.
You
know
saying
well,
I'm
not
doing
it
because
of
my
religious
beliefs.
So
is
that
did
anything
change
with
this?
Or
can
they
do
that
or
not.
Z
Melanie
scheibel
for
the
record.
This
does
not
change
the
existing
law
in
Nevada,
which
does
require
insurance
companies
to
cover
both
oral
contraceptives
and
emergency
contraceptives
and
requires
pharmacies
to
dispense
them.
A
A
And
if
there's
anyone
down
south
I
only
see
Connor,
so
if
there's
anyone
else,
okay,
anyone
else
down
there,
no
okay,
all
right!
Please
begin
when
you're
ready.
AC
Thank
you,
madam
chair
and
members
of
the
committee
Leah
case
l-e-a-c-a-s-e
here
today
on
behalf
of
the
Nevada
Public
Health
Association,
access
to
family
planning
and
appropriate
contraception
use
is
a
pillar
of
Reproductive
Rights
access
and
Justice,
so
just
wanted
to
get
on
the
record
that
Nevada
Public,
Health
Association,
has
supported
these
efforts
in
the
past
and
continues
to
support
today.
Thank
you.
AD
Thank
you,
chair
for
the
record
Tess
Opperman
here
on
behalf
of
the
Nevada
women's
Lobby,
the
Nevada
women's
Lobby
has
supported
the
prior
two
bills
to
do
with
this
12-month
contraceptive
and
the
ability
for
pharmacists
to
provide
contraceptives.
Our
understanding
is
that
this
is
not
happening
in
practice,
so
we
really
appreciate
this
cleanup
Bill
to
ensure
that
all
nevadans
are
able
to
access
contraceptives
we
at
least
from
the
list
online.
AD
O
Good
morning,
for
a
second
time,
Madam
chair
members
of
the
senate
committee
on
Commerce
and
labor
Brian,
Walker
senior,
vice
president
of
the
retail
association
of
Nevada.
We
are
greatly
in
favor
of
this
piece
of
legislation.
Like
the
two
that
came
before
me,
we
have
been
supportive
of
this
effort.
AB
Representing
Americans
for
contraception
and
to
your
point,
Madam
chair,
it
was
good,
seeing
my
organization
will
be
happy
to
see
a
Democrat
and
a
republican
picture
this
morning
with
that
said,
making
it
easier
for
Nevadas
to
receive
prescriptions
and
dispensing
of
contraceptions
is
sensible
policy,
so
I
just
want
to
come
out
and
support.
Thank
you.
A
Thank
you.
Anyone
else
here
in
Carson,
City
and
support
I,
don't
see
anyone
down
south
BPS.
Anyone
on
the
phones
and
support.
AE
Good
morning,
chair
members
of
the
committee,
my
name
is
Serena
Evans,
s-e-r-e-n-a-e-v-a-n-s
and
I'm
the
policy
director
for
the
Nevada
coalitions
and
Domestic
and
Sexual
Violence,
similar
to
those
that
came
before
me.
We
have
worked
on
these
pieces
of
legislation
in
the
past
and
we
are
incredibly
grateful
for
Senator,
scheibel
and
Senator
stone
for
doing
in-depth
research
and
figuring
out.
You
know
what
the
issue
was
and
why
this
wasn't
working
in
practice,
and
so
we
really
appreciate
this
attempt
to
improve
these
laws
and
increase
access
to
contraception.
Thank
you.
So
much.
U
Good
afternoon,
I'm,
sorry
good
morning,
I
think
still
and
members
of
the
committee
for
the
record.
My
name
is
Aaron
Rook
same
spelling
as
before.
I
live
in
Senate
District,
three
and
I'm
here
to
testify
supportive
Senate
bill,
352.
I'll,
keep
it
brief.
I
just
want
to
say
that
I
think
it's
really
important
to
ensure
easy
and
Equitable
access
to
12
month
contraception
and
lots
of
thank
Senator
stone
for
Lending
his
expertise
in
collaborating
with
Senator
scheibel,
as
we
work
collectively
to
increase
access
to
health
care
for
all.
U
Nebathans
I
really
hope
you
can
see
more
of
these
bipartisan
collaborations
that
really
honor
and
center
the
doctor-patient
relationship
over
politicize.
This
course
that
seeks
to
divide
us
so
with
that
I
urge
you
to
support
Senate
Bill
352
to
ensure
that
all
patients
with
the
ability
to
access
appropriate
contraception
when
and
where
they
need
it.
They
can
do.
T
AF
A
Thank
you
we'll
now
move
to
those
in
opposition,
starting
here
in
Carson,
City
and
anyone
down
south
to
anyone.
Bps.
Is
there
anyone
on
the
phones
in
opposition.
AG
Thank
you,
madam
chair.
My
name
is
Helen
Foley
and
I'm,
representing
the
Nevada
Association
of
Health
Plans.
Some
of
our
members
have
been
working
with
Senator
schaible
and
we're
very
close.
We
had
some
some
issues
that
we
needed
to
work
out
with
her
and
we
think
we're
real
close.
So
thank
you
very
much.
A
G
Thank
you,
madam
chair.
Our
Senator
Joe
Stone,
District
20.
I,
just
want
to
thank
the
the
committee
for
their
consideration,
I'd
like
to
respond
to
one
of
the
comments
that
was
made,
that
there
are
only
24
pharmacies
that
are
actually
providing
oral
contraceptives
right
now
and
I
can
tell
you
the
reason.
G
Why
is
that
the
way
the
laws
have
been
written
in
the
past
is
that
the
pharmacy
can
be
reimbursed
for
the
ingredient
cost
of
the
contraceptives,
but
there
is
no
reimbursement
to
the
pharmacist
for
their
time
in
ordering
the
contraceptives
so
I
think
this
bill
is
going
to
dramatically
increase
access,
because
now
that
the
pharmacy
owners,
whether
it
be
Rite,
Aid,
Walgreens
or
an
independent,
they
are
now
going
to
be
reimbursed
for
their
pharmacist
time
to
order
these
medications
and
dispense
them
and
therefore
I
think
you're
going
to
see
tremendous
access
and
I
think
it's
number
24
is
going
to
dramatically
increase
and
then
the
final
comment
I'll
make
is
that
you
know
pharmacists
are
some
of
the
most
highly
educated,
underutilized,
Healthcare
Professionals.
G
A
A
So
thank
you
all
for
your
for
your
testimony
and
you
know
I
just
make
one
comment.
I
am
I'm
really
glad
to
see
this
because
it's
I'm
always
I'm
always
conflicted.
If
you
will
seeing
people
who
who
reject
the
notion
that
contraceptives
should
be
easily
available,
etc,
etc
and
they're
usually
the
same
people
that
you
know
scoff
at
increasing
funding
for
Education
after
the
children
get
here.
You
know
something
like
helping
them
with
money
to
take
care
of
them
or
something
I
don't
know
anyway.
Madam.
G
Chair
Jeff
Stone
Senator,
just
on
for
the
record
just
one
more
time.
I
just
want
I'd
like
the
public,
just
to
know
that
I
am
a
licensed
pharmacist
in
California,
okay
and
I.
Don't
want
anyone
to
think
that
this
is
self-serving,
that
I'm
going
to
be
operating
in
a
pharmacy,
making
profit
for
myself,
I'm
kind
of
retired
and
I
plan
on
fully
retiring
very
soon.
So
I
just
don't
want
anybody
to
think
it
was
a
self-serving
interest
in
me,
participating
in.
A
This
world
yeah,
we
know
we
know
it's.
Okay,
thank
you!
So
much
next
we
will
move
on
to
hearing
on
Senate
Bill
355
measure
revises
Provisions
relating
to
financial
services.
Senator
Lang,
you
have
been
very
patient.
A
So
for
those
those
of
you
who
are
still
here
or
are
listening,
I
just
I
want
to
tell
you
we
do
something
in
Nevada,
oh
so,
I
I
think
we
do
something
in
Nevada
that
that
maybe
they
don't
do
all
over,
but
but
most
of
us
each
eat
lunch
together
every
day,
and
so
you
don't
have
the
same
type
of
vitriol
that
you
have.
You
know
with
people
doing
the
other
kind
of
stuff.
So
Washington
take
note.
Y
Thank
you,
Senator
Spearman
I
am
Roberta
Lang
representing
Senate
District
7
in
Clark,
County
and
I'm
joined
today
by
my
good
friend
and
colleague,
Senator
Scott
Hammond.
We
have
been
working
for
a
year
and
a
half
trying
to
pull
together
some
Financial
legislation
that
we
thought
would
be
helpful
in
our
state
and
what
you're
going
to
hear
today
is
a
result
of
those
stakeholder
meetings
that
we
had
once
a
month
for
during
the
interim.
Y
So,
as
we
all
know,
Nevada
relies
heavily
on
the
financial
institutes
to
keep
its
economy
running.
These
institutions
provide
vital
services
to
businesses
and
individuals
alike,
including
loans,
savings
accounts
and
investment
opportunities.
However,
the
licensing
process
for
these
institutions
is
sometimes
seen
as
overly
burdensome
and
time-consuming
which
can
discourage
potential
new
entrants
to
the
market.
This
is
particularly
concerning,
given
the
changing
nature
of
the
financial
sector,
with
many
new
fintech
firms
and
online
lenders
entering
this
space,
Nevada
wants
to
remain
competitive
in
its
changing
landscape.
Y
We
must
ensure
that
our
licensing
process
is
streamlined
and
efficient.
Another
area
that
requires
attention
is
the
regulation
of
protections
for
senior
citizens
and
vulnerable
vulnerable
persons
in
Nevada,
while
there
are
already
regulations
in
place
to
protect
these
consumers
and
ensure
that
financial
institutions
are
operating
in
a
safe
and
sound
manner,
these
regulations
must
be
updated
to
reflect
the
changing
nature
of
the
industry
with
the
rise
of
digital
technology.
Y
Many
lenders
are
are
now
able
to
provide
loans
to
borrowers
without
ever
meeting
them
in
person,
while
this
can
be
convenient
option
for
borrowers,
it
also
raises
concerns
about
fraud
and
identity
theft.
As
such,
there's
a
need
for
Clear
regulations
to
ensure
that
remote
lending
is
conducted
in
a
safe
and
secure
manner
by
streamlining
the
licensing
process,
updating
regulations
and
ensuring
the
safe
and
secure
and
remote
lending
Nevada
can
continue
to
attract
new
entrants
into
the
financial
sector
and
support
the
growth
of
its
economy,
and
with
that
I'll
have
Senator.
AH
You
thank
you,
madam
chair
and
members
of
the
Commerce
labor
and
Commerce
Committee.
It
is
my
privilege
to
be
here
together,
together
with
my
good
friend,
Senator
Lang.
She
brought
the
idea
to
my
attention.
I
thought
that
perhaps
we
needed
to
look
at
to
the
financial
section
and
see
if
we
couldn't
find
some
areas
of
common
interest.
It
was
actually
a
pleasure
to
meet
with
several
stakeholders
and
to
convene
with
them
often
and
talk
about
some
of
these
areas.
AH
That
would
be
of
benefit
to
several
communities,
as
well
as
a
Clarity
to
the
institutions,
and
so,
with
your
permission,
Madam
chair
again,
this
is
Senator.
Scott
Hammond,
representing
Senator
district
18
for
the
record
I'll
go
through
the
sections
of
the
bill.
Section.
One
removes
the
requirement
for
applicants
to
provide
a
physical
address
for
the
main
office
of
the
proposed
depository
institution
during
the
licensing
process.
Instead,
the
commissioner
of
financial
institutions
can
require
the
applicant
to
provide
a
general
location
and
submit
the
physical
address
before
commencing
business
operations.
AH
Section
3
of
the
bill
extends
the
existing
Provisions
governing
requirements
for
a
financial
institution
to
report
known
or
suspected
exploitation
of
older
or
vulnerable
persons
to
include
procedures
that
a
financial
institution
may
take
to
temporarily
delay
a
requested
disbursement
from
or
transaction
involving
an
account
of
an
older
or
vulnerable
person
in
Section
5.
The
legislation
permits
employees
of
licensed
lending
businesses
to
work
remotely,
provided
they
adhere
to
certain
requirements.
This
measure
adapts
to
the
changing
landscape
of
work,
allowing
businesses
to
adapt
and
innovate
in
their
operations.
AF
Chair
Spearman
members
of
the
committee,
my
name
is
Connor
Kane
I'm
here
on
behalf
of
the
Nevada
Bankers
Association.
I
do
also
have
some
remarks
prepared
in
support
of
this
bill,
but
I
think
first
I'll
walk
you
through
the
amendment
that
we've
submitted
today,
which
we
believe
is
a
friendly
Amendment
and
we've
communicated
with
the
sponsors
of
the
bill.
AF
So
there
are
three
items
in
the
amendment:
if
you
all
have
it,
have
it
in
front
of
you,
the
the
first,
the
first
change,
the
intent
there
is
to
clarify
some
of
the
protections
that
already
exist
in
law
when
we
do
see
a
suspicious
transaction
or
or
disbursement.
Our
our
financial
institutions
and
and
their
designated
reporter
are
required
to
report
the
transaction
to
aging
and
disability
services
and
law
enforcement,
and
that's
that's
pursuant
to
section
three
subsection:
two.
AF
The
the
the
second
change
would
allow
for
the
designated
reporter
to
proceed
with
the
transaction
or
disbursement
once
they
reason
once
they
reasonably
believe
it
will
not
result
in
the
financial
exploitation
of
the
older
vulnerable
person.
The
idea
here
is
that
we
do
not
want
to
unnecessarily
delay
a
transaction
and
again
this
bill
requires
that
reporter
to
make
make
the
report
to
the
Aging
and
Disability
Services
and
law
enforcement.
The
amendment
would
not
change
that
requirement.
AF
The
the
Third
change
and
and
I'll
talk
about
this
a
little
bit
more
later,
but
the
tools
that
that
fraudsters
are
using
to
Target,
seniors
and
vulnerable
persons
are
constantly
evolving.
We
believe
it's
helpful
in
section
three
subsection
nine
to
have
criteria
that
a
reporter
may
consider,
but
we
think
that
it's
important
that
the
criteria
remains
permissive
in
statute,
as,
as
this
will
continue
to
be
a
moving
Target.
So
we
we
believe
that
making
that
that
language
permissive
is
is
also
very
important
and
I'm
happy
to
answer
any
questions.
F
Nothing
bad
come
on
so
and
I
just
wanted
to
get
and
I
appreciate
the
the
amendment
and
all
that
stuff,
but-
and
he
I
think
he
answered
the
question
I
had
about
the
notices
and
all
that
stuff,
so
people
can
come
in
and
get
it
taken
off
if
once
they're
notified.
F
But
how
does
that
happen?
It
says
they
have
to
notify
within
two
days.
Is
that
by
mail
electronically?
Do
they
call
because
it
could
take
quite
a
bit
of
time
and
then
a
person
had
a
transaction
that
they
needed
to
have
happen
and
it
gets
delayed
five
days
before
they
know,
because
things
went
in
the
mail
I'm
just
curious.
How
that
currently
works
because
there's
some
existing
provisions
on
this
already
I
just
didn't
know
how
it
worked.
But
we
do
want
to
protect
people.
That's
for
sure.
Y
Center
Lang
for
the
record.
Thank
you
for
the
question
sender
daily.
Yes,
so
the
banks
already
do
this.
They
contact
someone
by
phone
right
away
and
if
they
can't
get
the
person
they're
calling
a
relative
to
see
if
they
can,
where
they
can
find
the
person,
because
it's
really
important
to
have
that
personal
contact
as
soon
as
possible.
Y
I,
don't
know
if
any
of
you
have
ever
had
your
bank
account
hacked
by
somebody,
but
it's
not
a
fun
situation.
I
have,
and
it
is
not
fun.
So
the
sooner
you
can
get
to
the
person
that
owns
the
account
the
better.
F
Agreed,
thank
you.
I
just
wanted
to
see
how
that
was
actually
happening.
Males,
probably
snail
mail
is
probably
the
last
resort,
but
and
then
final
question
and
I
know
you
changed
the
language
on
the
breach
and
it
pretty
much
parallels.
What's
already
in
law,
you
took
them
out
of
the
one
section,
but
there's
a
couple
things:
can
you
maybe
explain
the
difference
on
why
why
you
did
that
I
know
some
of
the
thresholds
on
the
numbers
were
different.
F
As
I
read
through
the
two
sections,
I
think
it's
section,
nine
regarding
confidentiality
breaches
in
the
reporting.
F
No
worries
I,
think
section,
17
is
where
you
removed
it
and
you
add
it
into
section
9
which
parallels,
but
it's
slightly
different
I
was
just
wondering
what
you
were
thinking
about
on
that.
Y
Okay,
will
you
Senator
Spearman
if
we
could
have
Senator
daily,
restate
the
question
and
give
us
the
exact
section
and
place
in
nine
that
he's
speaking
up?
That
would
be
terrific,
hey.
F
Not
there
yet
age
16
is
where
you
have
the
amendment,
and
it
says
the
provision
this
section
do
not
apply
to
a
person
license
pursuant
to
chapter
675
of
NRS,
so
you
exclude
the
banking
system
from
that
disclosure
process.
That's
already
an
existing
law
and
you
replace
that,
and
it's
very
similar
with
section
nine
I,
just
curious
what
the
differences
were
and
why
that
other
section
weren't
the
only
thing
I
could
really
see
in
it.
When
you
looked
at
it
was
some
of
the
thresholds
on
the
number
of
people
and
various
things.
F
J
Y
X
Thank
you
and
and
I'm
happy
to
go
back
in
and
look
at
the
two
sections.
Compare
them
and
I
can
get
an
email
out
to
the
committee
on
where
the
differences
are
and
if
there
was
any
reason
for
that.
F
That
worked
for
me
and
the
only
reason
I
really
remember
that,
because
one
of
our
colleagues
who
was
in
the
assembly
is
now
over
here
in
his
very
first
session,
I
was
lobbying
at
the
time
made
a
change
in
that
disclosure
on
on
that
information.
I
had
a
few
questions
on
it.
I
remember
going
talking
to
him.
F
So
when
I
saw
that
change
I
said
what
are
we
doing
different
and
if
it
was
just
a
drafting
thing
and
there's
no
real
reason
for
it
and,
like
I
said,
the
only
thing
I
really
saw
that
was
different
was
the
numbers
of
people
that
triggered
certain
certain
things.
So
I
would
be
happy
to
hear
from
our
legal
counsel
on
that
and
appreciate
it.
A
Thank
you,
Senator
Stone,.
G
Thank
you.
Thank
you,
madam
chair,
and
thank
you,
Senators
Lang
and
my
good
friend
Scott
Hammond,
for
bringing
us
forward
I'd
like
to
give
you
just
a
real
life
example
of
something
happened
to
a
a
tenant
of
mine,
which
was
just
so
disturbing
in
how
if
this
is
passed,
which
I
certainly
hope
it
is
how
it
might
have
effectuated
a
different
conclusion.
So
this
was
a
89
year
old
veteran
that
was
widowed
moved
into
an
apartment
with
his
dog
retired.
G
With
a
hundred
and
fifty
thousand
dollars
in
the
bank
became
very
lonely
was
on
Facebook
and
somebody
took
a
liking
to
him.
They
developed
a
relationship
and,
of
course
the
person
was
having
some
financial
difficulties
and
he
would
go
into
the
bank
and
he
would
be
sending
five
figured
wires
to
this
person.
He
felt
he
was
in
love
with
and
wanted
to
have
a
long-term
relationship
with,
and
the
only
question
that
he
got
from
a
National
Bank
was
Mr
C.
G
All
one
hundred
and
fifty
thousand
dollars
of
his
money
and
now
lives
on
Social
Security
in
a
small
pension
that
he
has
so
that's
an
extreme
case
of,
but
it's
something
that
we're
certainly
trying
to
prevent
and
and
he
and
he
went
to
get,
do
a
police
report
on
this
and
the
policeman
said
you
know
I'll
do
the
report,
but
you
know
once
you
wire
the
money
outside
the
United
States,
there's
no
way
for
us
to
go
back
to
get
your
money.
G
Unfortunately,
so
we
really
don't
even
know
the
true
incidence
of
this
thievery,
that's
going
on
not
only
in
Nevada
but
across
this
country,
especially
to
our
vulnerable
populations.
Our
seniors,
our
our
citizens
with
disabilities,
so
explain
to
me
how
we
would
protect
somebody
like
Mr
C,
that
that
would
ensure
that
the
bank
is
following
their
confidentiality
laws.
G
I,
especially
like
the
provision
on
page
four
number,
two
line:
16
notifies
the
local
Office
of
Aging
and
Disability
Services
of
the
Department
of
Health
and
Human
Services
and
appropriate
law
enforcement
agency
of
any
new
information
is
relevant
to
the
delay
within
a
reasonable
period
of
time.
After
becoming
aware
of
the
information,
what
can
what
can
the
Office
of
Aging
do
to
to
intervene
when
you
have
some
people
that
are
just
so
obstinate
that
this
is
my
lover?
G
I
want
to
send
the
money
and
there's
nothing
you're
going
to
do
to
stop
me
when,
in
fact,
they
may
not
have
any
other
next
of
kin
to
help
prevent
that
and
I'm
not
sure
we
can
help
this
person
in
a
case
like
that.
But
certainly
your
legislation
helps
us
get
there,
but
I'd
like
to
hear
what
you're
your
bill
would
probably
do
to
help
this
individual
out.
Y
Thank
you,
cinderstone
Senator
Lang
for
the
record,
so
you're,
absolutely
right,
I
mean
I.
Think
the
the
Aging
organization
helps
us
get
to
a
place
where
that's
another
step
that
we
can
take.
I.
Think
that
the
bank
is
another
step
we
can
take
and
I
think
we
put
all
those
together.
It's
in
and
you're
absolutely
right.
When
you
have
someone
that
thinks
they're
finding
someone
they're
in
love
with,
and
they
want
to
send
them
money.
They
don't
want
to
not
send
them
money
and
that's
exactly
what
this
legislation
is
about.
Y
G
I
I
agree,
I,
agree
and
I
applaud
everything.
You're
doing
and
I
would
just
further
emphasize
that
I
think
that
Banks
need
to
be
held
a
little
bit
more
accountable
for
when
they
see
an
elderly
person
coming
in
and
wiring.
You
know
ten
thousand
fifty
thousand
dollars
to
a
person
and
just
I
think
there
needs
to
be
more
than
just
asking
do
you
know
this
person,
and
maybe
we
need
some
tightening
of
regulations
that
ensures
that
a
senior
citizen
must
put
an
emergency
contact
on
their
application.
G
AH
If
I
could
Madam
chair,
Senator
Hammer
For,
the
record
I
wanted
to
address
your
question
one
of
the
things
that
was
always
it's
always
interesting
when
you
sit
down
and
start
talking
about
here
are
some
issues
that
we'd
like
to
address,
and
then
you
start
bringing
in
stakeholders
who
have
an
interest
the
same
interest
in
those
in
similar
areas.
It's
always
interesting.
The
conversations
that
occur
and
that's
exactly
what
happened
as
Senator
Lang
had
mentioned.
AH
We've
been
doing
this
for
about
a
year
and
a
half,
and
we
had
you
know
several
stakeholder
meetings
and
as
we
started,
bringing
them
in
it's
just
like
anytime.
We
are
dealing
with
an
issue,
the
more
you
have
different
actors
in
the
room.
They
start
to
talk
to
each
other
about.
Well,
you
know
we
can
do
this
or
we
can
do
that,
and
so
so,
just
having
different
I
mean
very
disparate
sort
of
Industries.
AH
You
have
you
know
that
learning
this
the
Aging
and
you
know
you
have
those
agencies
that
are
helping
out
those
who
are
aging
and
and
have
disabilities.
But
you
also
have
the
banking
industry
and
they're
all
sitting
around
talking
about
what
can
we
do
to
help
each
other
out
or
how
can
we
help
notify?
That's
the
conversations
that
were
happening
and,
as
a
result,
some
of
the
some
of
the
the
conversation
got
involved
or
got
wrapped
up
into
our
legislation
here.
AH
But
that's
exactly
what
we're
trying
to
do
is
figure
out.
You
know
what,
as
a
banking
industry,
can
we
do
further
than
we
do
right
now
to
help
out?
And
so
that's
that's
how
we
came
up
with
some
of
the
language
and.
G
I
applaud
you
both
for
taking
a
stab
at
this
and
protecting
these
vulnerable
populations
from
further
incursions
and
I
look
forward
to
voting
yes
on
this
Bill.
Thank
you.
A
Thank
you
and
if
I
can
get
Brian
or
lcb2
I
think
that
we
have
in
statute
something
like
enhanced
penalties
when
it
involves
an
older
person.
Can
you
speak
to
that?
Please.
X
There
are
for
various
and
I
can
find
this
section
really
quick
here
for
various
offenses
that
are
committed
against
persons
60
years
and
older.
There
are
enhanced
penalties
and
I
can
quickly
look
up
the
offenses
that
that
would
apply
to,
but
I
think
it
would
definitely.
It
definitely
applies
to
financial
exploitation,
type
offenses,
there's
enhanced
penalties
that
apply
to
those
crimes
when
they're
committed
against
persons,
60
and
older.
A
Thank
you,
Senator.
AA
What
a
wonderful
bill
you
two
I
when
my
son
was
serving
overseas
in
Korea
on
the
demilitarian
Zone,
my
my
father
had
received
a
phone
call
from
Jamaica
and
they
were
saying
that
he
was
in
jail
and
there
were
horrible
things
happening
to
him,
and
my
father
went
immediately
to
Walmart
to
wire
money.
He
didn't
call
me
because
I
would
have
told
him
no
he's
in
Korea
he's
not
in
Jamaica,
but
my
father
went
and
it
was
because
of
the
people
at
Walmart.
AA
That
said,
wait
before
you
do
anything,
you
need
to
call
your
family
and
make
sure
that
you
know
so.
I
love
the
stops
that
they
put
in
place
with
this
and
I
like
this
bill,
I'd
like
to
see
it
expanded
to
maybe
all
the
places
that
you
can
wire
money
that
there's
you
know
like
three
or
four
questions
that
you
have
to
ask
or
more
stops
that
you
have
to
put
in
place
because
he
could
have
easily
had
that
happen.
AA
I
think
my
dad
wanted
to
protect
me
because
then
he
ended
up
calling
my
husband
who's
in
law
enforcement
and
getting
him
involved.
My
my
husband's
like
absolutely
not
give
me
the
number
that
called
you,
but
there
does
need
to
be
stops
in
place
and
then
maybe
connections
with
law
enforcement
right
away.
There's
not
probably
much
that
can
be
done.
AA
You
know
in
Jamaica
or
wherever
this
call
was
coming
from,
but
it
is
alarming,
and
especially
with
just
the
high
stress
that
my
father
thought
for
sure
horrible
things
was
happening
to
my
son
and
it
was
you
know
it
wasn't
my
son
so
anyway.
Thank
you
so
much
for
the
Bell.
A
AF
Why
is
this
so
important?
Adults,
65
and
older
lost
more
dollars
to
fraudsters
than
any
other
age
group.
One
in
five
have
been
victimized
with
women
twice
nearly
twice
as
likely
to
be
victims.
They
are
targeted
because
they
have
money
or
assets
are
trusting
of
others.
Often
live
away
from
family
members
can
have
technological
challenges,
although
I'm
proof
that
you
don't
have
to
be
over
65
to
have
technological
challenges
and,
in
certain
circumstances,
maybe
mentally
or
physically
vulnerable
Nevada
in
our
current
statutes.
AF
We're
behind
many
other
states,
the
first
state
to
allow
financial
institutions
to
pause
a
transaction
when
Financial
abuse
was
suspected
was
Washington
in
2010..
Since
then,
States
across
the
country
have
enacted
report
and
hold
laws
that
provide
financial
institutions
and
their
employees
the
tools
that
they
need
to
protect,
seniors
and
other
vulnerable
persons.
AF
So,
in
some
of
the
examples
we
were
talking
about
today,
where
somebody
comes
into
the
bank
and
they
say
I'd
like
to
transfer,
you
know
ten
thousand
dollars
to
this
remote
location
and
it's
not
a
transaction
that
would
be
be
typical
for
them.
A
bank
would
currently
have
the
ability
to
report
to
report
that
transaction.
You
could
report
to
aging
and
disability
local
law
enforcement,
but
they
wouldn't
necessarily
have
the
ability
to
place
a
hold
on
the
transaction
and
and
that's
what
we're
trying
to
accomplish
in
this
legislation
to
help
protect
our
seniors.
AF
A
Committee
questions
I
think
you
did
a
fine
job.
Anyone
here
in
Carson,
City
I,
don't
think
so
BPS
we
have
anybody
on
the
phones.
A
A
A
Y
Thank
you,
Sandra
Lang,
for
the
record,
chair
Spearman.
Thank
you.
So
much
for
hearing
this
bill
I
think
it's
a
great
opportunity
to
modernize
the
process
and
adopt
to
the
evolving
needs
of
the
financial
industry,
while
ensuring
Safety
and
Security
of
customer
information.
So
I
urge
the
committee
to
support
this
bill
and
we
look
forward
to
it
moving
on.
Thank
you.
A
Thank
you
and
with
that
we
will
close
a
hearing
on
Senate,
Bill,
355
and
now
open
it
up
to
public
comment.
Put
a
comments.
Listen,
let's
limited
limited
to
two
minutes
and
put
a
comment
cannot
will
not
does
not
speak
to
anything
that
we've
covered
in
terms
of
the
bills
that
we've
looked
at
today.
So
I
don't
see
anyone
here,
I
see
one
in
Las,
Vegas
BPS.
We
have
anyone
on
the
phones.
A
Thank
you
and
with
that
we
will
close
this
edition
of
the
senate
committee
on
Commerce
and
labor,
and
we
will
see
you
all
back
here,
bright
and
early
on
at
eight
o'clock.
There's
a
rumor
floating
around
that,
as
today
is
Friday
tomorrow
will
be
Saturday,
so
enjoy
your
weekend.
Okay,
we
are
adjourned.