Pharmacy benefit manager regulations updated

Provisions of law related to pharmacy benefit managers were updated by passage of a bill May 14.

LB198, sponsored by Elkhorn Sen. Tony Sorrentino, makes a number of changes to the Pharmacy Benefit Manager Licensure and Regulation Act.

Under the bill, PBMs are prohibited from imposing stricter terms on unaffiliated specialty pharmacies than on their own affiliated entities. The measure also makes 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.

LB198 also prohibits 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;
• automatically enrolling individuals in mail-order services, with a 90-day exception for new maintenance medications; and
• retaliating against pharmacies and pharmacists for refusing to dispense drugs if reimbursement is below their cost of acquisition.

Finally, beginning Jan. 1, 2026, new PBM health plan contracts cannot 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 takes effect Jan. 1, 2029.

Lawmakers passed LB198 on a 49-0 vote.