Pharmacy benefit manager changes advanced

Lawmakers gave first-round approval May 1 to a bill that would update provisions of law related to pharmacy benefit managers.

LB198, as introduced by Elkhorn Sen. Tony Sorrentino, would make a number of changes to the Pharmacy Benefit Manager Licensure and Regulation Act. A Banking, Commerce and Insurance Committee amendment, adopted 37-0, replaced the bill with a modified version of the proposal.

Sorrentino said the three largest PBMs manage benefits for approximately 80% of Americans and that the amended LB198 would benefit employers who sponsor health plans and, in turn, every Nebraskan.

Under the amendment, PBMs would be prohibited from imposing stricter terms on unaffiliated specialty pharmacies than on their own affiliated entities. The amendment also would make a number of changes to the regulation of clinician-administered drugs.

Among those changes is a requirement that specialty pharmacies that ship clinician-administered drugs adhere to federal shipping laws, provide 24/7 pharmacist and nurse access, allow refill requests post-utilization review and comply with federal tracking and tracing requirements.

The amendment also would prohibit health plans, carriers and PBMs from:
• mandating exclusive use of mail-order or affiliated pharmacies for payment and reimbursement;
• preventing individuals from choosing network pharmacies;
• transferring prescriptions without consent; and
• automatically enrolling individuals in mail-order services, with a 90-day exception for new maintenance medications.

In addition, the amendment would prohibit PBMs and related entities from retaliating against pharmacies and pharmacists for refusing to dispense drugs if reimbursement is below their cost of acquisition and require them to provide patients with information on alternatives.

Finally, beginning Jan. 1, 2026, new PBM health plan contracts could not include spread pricing — a practice in which a PBM charges a health plan more for a medication than it pays to the pharmacy — unless it’s an extension of a preexisting spread pricing contract. A full prohibition on spread pricing would take effect Jan. 1, 2029.

North Platte Sen. Mike Jacobson, chairperson of the committee, said more changes are needed but that the amendment deals with the “low-hanging fruit” in terms of increasing fairness within the PBM system.

“This measure is critical for bringing transparency to drug pricing and ensuring that health care plans are paying the actual cost of medications,” Jacobson said, adding that the committee plans an interim study to examine further changes.

Following adoption of an additional technical amendment, LB198 was advanced to select file on a 39-0 vote.