{"id":38993,"date":"2025-05-15T14:13:51","date_gmt":"2025-05-15T20:13:51","guid":{"rendered":"https:\/\/update.legislature.ne.gov\/?p=38993"},"modified":"2025-05-15T14:13:51","modified_gmt":"2025-05-15T20:13:51","slug":"pharmacy-benefit-manager-regulations-updated","status":"publish","type":"post","link":"https:\/\/update.legislature.ne.gov\/?p=38993","title":{"rendered":"Pharmacy benefit manager regulations updated"},"content":{"rendered":"

Provisions of law related to pharmacy benefit managers were updated by passage of a bill May 14.<\/p>\n

\"\"
Sen. Tony Sorrentino<\/figcaption><\/figure>\n

LB198, sponsored by Elkhorn Sen. Tony Sorrentino, makes a number of changes to the Pharmacy Benefit Manager Licensure and Regulation Act.<\/p>\n

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.<\/p>\n

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.<\/p>\n

LB198 also prohibits health plans, carriers and PBMs from:
\n\u2022 mandating exclusive use of mail-order or affiliated pharmacies for payment and reimbursement;
\n\u2022 preventing individuals from choosing network pharmacies;
\n\u2022 transferring prescriptions without consent;
\n\u2022 automatically enrolling individuals in mail-order services, with a 90-day exception for new maintenance medications; and
\n\u2022 retaliating against pharmacies and pharmacists for refusing to dispense drugs if reimbursement is below their cost of acquisition.<\/p>\n

Finally, beginning Jan. 1, 2026, new PBM health plan contracts cannot include spread pricing \u2014 a practice in which a PBM charges a health plan more for a medication than it pays to the pharmacy \u2014 unless it\u2019s an extension of a preexisting spread pricing contract. A full prohibition on spread pricing takes effect Jan. 1, 2029.<\/p>\n

Lawmakers passed LB198 on a 49-0 vote.<\/p>\n","protected":false},"excerpt":{"rendered":"

Provisions of law related to pharmacy benefit managers were updated by passage of a bill May 14.<\/p>\n","protected":false},"author":1,"featured_media":36724,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"colormag_page_container_layout":"default_layout","colormag_page_sidebar_layout":"default_layout","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[6],"tags":[309],"class_list":["post-38993","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-banking-commerce-and-insurance","tag-sen-tony-sorrentino"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/update.legislature.ne.gov\/wp-content\/uploads\/2024\/07\/UpdateBlogPhoto-3.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=\/wp\/v2\/posts\/38993","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=38993"}],"version-history":[{"count":2,"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=\/wp\/v2\/posts\/38993\/revisions"}],"predecessor-version":[{"id":38995,"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=\/wp\/v2\/posts\/38993\/revisions\/38995"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=\/wp\/v2\/media\/36724"}],"wp:attachment":[{"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=38993"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=38993"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/update.legislature.ne.gov\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=38993"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}