This article covers Nevada workers' compensation reimbursement rules for pharmaceuticals and Durable Medical Equipment (DME).
Providers can see here for the 2026 Nevada Workers' Compensation Medical Fee Schedule, effective February 1, 2026.
Pharmacy Reimbursement
An insurer shall reimburse all pharmaceuticals, except those provided to an injured employee occupying a bed in the hospital, at the average wholesale price plus a $13.70 dispensing fee, or the provider’s usual and customary price, whichever is less, unless there is a written agreement between the insurer and provider for a lower reimbursement. Physician dispensed controlled substances are addressed in NRS 616C.117.
Prior authorization is required for any compound medication or specific subset of compounds.
The prior authorization request must include the prescribing physician’s or chiropractor’s justification of the medical necessity for and efficacy of the compound instead of or in addition to the standard medication therapies.
All bills for compound medications shall list each ingredient of the compound at the individual ingredient level and, where applicable, include a valid National Drug Code (NDC) for each ingredient.
The insurer and dispensing provider shall agree upon the quantity as well as the reimbursement for a compounded medication before the medication is dispensed.
The insurer shall not be required to reimburse any compound ingredient that lacks a valid NDC.
Durable Medical Equipment (DME) Reimbursement
An insurer shall reimburse the provider of health care for those medical supplies and materials provided by the health care provider at the provider’s actual cost, excluding tax and charges for freight, plus 20 percent, unless there is a written agreement between the insurer and provider for a lower reimbursement.
Copies of the manufacturers’ or suppliers’ invoice from the provider are required for reimbursement.
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