Nebraska Legislative Bill 767 Establishes Regulations of Pharmacy Benefit Managers (PBMs)
On March 16, 2022, Governor Pete Ricketts approved an important bill for Nebraska’s independent pharmacies. Legislative Bill 767, also known as the Pharmacy Benefit Manager (PBM) Licensure and Regulation Act (“Act”), creates regulations that benefit Nebraska pharmacies by introducing much-needed PBM oversight in the state. The Act, previously introduced by Senator Mark Kolterman, was unanimously passed by the Nebraska Legislature.
Importantly, Nebraska is a state with several rural communities that rely on independent community pharmacies to fill their prescriptions—this distinction also results in unique challenges arising from improper PBM practices.
The Act is set to take effect on January 1, 2023 and includes provisions that:
- Require PBMs to obtain a PBM license to conduct business in the state;
- Prohibit PBMs from restricting pharmacies from disclosing to patients any health care information that the pharmacist deems appropriate including the nature of the treatment, alternative therapy, the process used to authorize or deny health care service and information related to any financial incentive used by the health carrier;
- Allow pharmacists to discuss information related to the total cost for a prescription drug and sell a more affordable alternative drug;
- Provide regulations related to PBM audits of pharmacies;
- Require PBMs to update the maximum allowable cost (MAC) price list at least every seven days;
- Establish appeal processes for pharmacies to appeal both a preliminary audit report and a final audit report as well as disputes related to MAC reimbursement;
- Prohibit PBMs from discriminating against 340B contract pharmacies; and
- The State may audit the PBM’s books and records to determine compliance with the Act and impose monetary penalties for violations of the Act.
This new legislation is significant and serves as a substantial improvement to Nebraska’s current PBM laws and provides independent pharmacies with several new tools to combat improper practices by PBMs. Thus, independent pharmacies should take the steps now to become familiar with the Act so they are prepared to take action, if needed, in 2023.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the U.S. in challenging PBM audits, network access, reimbursement practices and has extensive knowledge on all aspects of the pharmacy-PBM relationship. Contact us today to speak with an attorney about how your pharmacy can leverage the various laws and protections afforded to pharmacies, including state PBM laws in effect in numerous states, including Nebraska, in addition to important federal laws which regulate PBM conduct.