This bill amends the Pharmacy Benefit Manager Licensure and Regulation Act in Nebraska, introducing several key changes aimed at enhancing the regulation of pharmacy benefit managers (PBMs). It defines and redefines various terms related to PBM operations, including the introduction of "pharmacy acquisition cost" and "spread pricing." The bill prohibits PBMs from engaging in spread pricing, which is defined as charging an amount exceeding the ingredient cost of a prescription drug plus any dispensing fee. Additionally, it establishes new duties for PBMs, requiring them to act with care, skill, and transparency in their dealings with covered persons, health benefit plans, and providers.

The bill also modifies the appeal process for pharmacies regarding maximum allowable cost price lists, mandating that PBMs update these lists regularly and provide a clear process for dispute resolution. It stipulates that pharmacies cannot be reimbursed less than what is paid to PBM affiliates for the same services and prohibits patient steering to PBM affiliates. Enforcement provisions are strengthened, allowing the Director of Insurance to suspend or revoke PBM licenses and impose monetary penalties for violations. Overall, the bill aims to create a more equitable and transparent environment for pharmacy benefit management in Nebraska.

Statutes affected:
Introduced: 44-4601, 44-4603, 44-4608, 44-4611