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 definitions for terms such as "clinician-administered drug," "specialty pharmacy," and "spread pricing," which refers to the discrepancy between the costs charged to health plans and what pharmacies receive. 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 sets forth requirements for specialty pharmacies that ship clinician-administered drugs, including adherence to federal regulations and 24/7 pharmacist access for inquiries. It restricts 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 mandates that if a pharmacy declines to fill a prescription, they must inform the patient of alternative options and prohibits PBMs from retaliating against pharmacies for such decisions. The bill addresses spread pricing by prohibiting its inclusion in contracts after January 1, 2026, with a complete ban by January 1, 2029, and it will take effect on January 1, 2026, while repealing 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