The bill amends the Pharmacy Benefit Manager Licensure and Regulation Act to strengthen the oversight of pharmacy benefit managers (PBMs) and their relationships with pharmacies and health benefit plans. It introduces new definitions, including "clinician-administered drug," "specialty pharmacy," and "spread pricing," which describes the discrepancy between the cost charged to a health benefit plan and what is paid to the pharmacy. The legislation prohibits PBMs from excluding Nebraska pharmacies from specialty networks if they meet accreditation standards and ensures that PBMs cannot impose stricter terms on unaffiliated specialty pharmacies compared to their affiliated counterparts. Additionally, network pharmacies are allowed to refuse to provide drugs if the reimbursement is below acquisition cost.

The bill also establishes requirements for specialty pharmacies shipping clinician-administered drugs, mandates compliance with federal regulations, and ensures patient access to pharmacists for inquiries. It prohibits health benefit plans and PBMs from mandating exclusive use of mail-order services, transferring prescriptions without consent, or using financial incentives that favor PBM-affiliated pharmacies. Furthermore, it protects network pharmacies and pharmacists from penalties for declining to provide drugs and allows retail pharmacies to offer delivery services without facing network removal. The bill addresses spread pricing by prohibiting its inclusion in contracts after January 1, 2026, and mandates that all contracts exclude spread pricing by January 1, 2029. The act will become operative on January 1, 2026, and repeals certain sections of the Revised Statutes Cumulative Supplement, 2024.

Statutes affected:
Introduced: 44-4601, 44-4603, 44-4608, 44-4611
Final Reading: 44-4601, 44-4603, 44-4610
Slip Law: 44-4601, 44-4603, 44-4610