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NebraskaLB198109th Legislature 1st and 2nd SessionslegislatureWALLET

Change provisions of the Pharmacy Benefit Manager Licensure and Regulation Act

Sponsored By: Tony Sorrentino

Signed by Governor

Banking, Commerce and Insurance Committee

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 6 benefits, 0 costs, 1 mixed.

PBM spread pricing ends by 2029

Beginning January 1, 2026, new contracts between pharmacy benefit managers (PBMs) and health plans cannot include spread pricing, except extensions of pre‑2026 contracts that already had it. Beginning January 1, 2029, spread pricing is banned in all PBM–plan contracts.

No forced mail-order for prescriptions

Health plans, carriers, and PBMs cannot force you to use mail-order or a PBM affiliate pharmacy. They cannot block you from picking any network pharmacy or move your prescription without your request. They cannot use cost-sharing incentives that favor an affiliate. Plans may auto-enroll you in mail-order only for maintenance drugs after 90 days on a new maintenance drug, and you can opt out anytime. Plans may still require use of a network specialty pharmacy in limited cases.

Safer delivery of clinic-given drugs

Specialty pharmacies that ship clinician-administered drugs must follow federal shipping and drug tracing laws and give providers 24/7 pharmacist or nurse access. Providers and patients can request refills under normal plan review rules. Providers must schedule delivery at least five business days ahead and sign for shipments sent to the provider. If the drug is not delivered as scheduled, the patient does not have to pay. PBMs and carriers must offer an appeal when delivery fails or when a provider reasonably believes a patient needs an in-stock drug right away. Some shared-ownership shipments are exempt.

Pharmacies can refuse below-cost fills

A network pharmacy or pharmacist may refuse to fill a drug when payment is below its acquisition cost. If they refuse, they must tell the patient where to fill it or refer them to the plan sponsor. PBMs, PSAOs, or their agents cannot punish or remove the pharmacy just for refusing for this reason.

Fair network rules for specialty pharmacies

A PBM cannot exclude a Nebraska specialty pharmacy from its specialty network if the pharmacy is nationally accredited and accepts the PBM’s terms. PBMs cannot give unaffiliated specialty pharmacies stricter rules than affiliates or impose terms that conflict with this law. PBMs may not demand data more often than quarterly unless needed for legal reporting, payment integrity, rebates, or accreditation submissions.

New pharmacy benefit manager definitions

The law updates key terms used in PBM rules, including clinician‑administered drug, maintenance medication, network pharmacist and pharmacy, pharmacy benefit manager and affiliate, PSAO, specialty pharmacy, and spread pricing. Beginning January 1, 2026, it defines retail pharmacy for the delivery provisions. It repeals sections 44‑4601, 44‑4603, and 44‑4610 effective January 1, 2026.

Retail pharmacy delivery rights and fees

Starting January 1, 2026, contracts cannot bar retail pharmacies from offering delivery by mail, carrier, or staff when the patient asks before delivery. PBMs and plan sponsors cannot drop a retail pharmacy from networks or force it into a mail‑order network just for offering allowed delivery. Unless the contract says otherwise, a retail pharmacy cannot bill the plan sponsor or PBM for delivery. If a pharmacy charges a patient a delivery fee, it must disclose the fee and state that the plan sponsor or PBM may not reimburse it.

Sponsors & Cosponsors

Sponsor

  • Tony Sorrentino

    Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 234 • No: 0

legislature vote • 5/14/2025

Final Reading

Yes: 49 • No: 0

legislature vote • 5/1/2025

Vote

Yes: 36 • No: 0 • Other: 13

legislature vote • 5/1/2025

Vote

Yes: 37 • No: 0 • Other: 12

legislature vote • 5/1/2025

Vote

Yes: 39 • No: 0 • Other: 10

legislature vote • Unknown

Vote

Yes: 37 • No: 0 • Other: 12

legislature vote • Unknown

Vote

Yes: 36 • No: 0 • Other: 13

Actions Timeline

  1. Provisions/portions of LB109 amended into LB198 by AM1201

    6/6/2025legislature

  2. Approved by Governor on May 20, 2025

    5/20/2025legislature

  3. Presented to Governor on May 14, 2025

    5/14/2025legislature

  4. President/Speaker signed

    5/14/2025legislature

  5. Passed on Final Reading 49-0-0

    5/14/2025legislature

  6. Dispensing of reading at large approved

    5/14/2025legislature

  7. Placed on Final Reading

    5/12/2025legislature

  8. Advanced to Enrollment and Review for Engrossment

    5/8/2025legislature

  9. Enrollment and Review ER76 adopted

    5/8/2025legislature

  10. Enrollment and Review ER76 filed

    5/7/2025legislature

  11. Placed on Select File with ER76

    5/7/2025legislature

  12. Advanced to Enrollment and Review Initial

    5/1/2025legislature

  13. Banking, Commerce and Insurance AM1201 adopted

    5/1/2025legislature

  14. Jacobson AM1229 adopted

    5/1/2025legislature

  15. Jacobson AM1229 to AM1201 filed

    5/1/2025legislature

  16. Banking, Commerce and Insurance AM1201 filed

    4/29/2025legislature

  17. Placed on General File with AM1201

    4/29/2025legislature

  18. Banking, Commerce and Insurance priority bill

    3/12/2025legislature

  19. Sanders name added

    3/6/2025legislature

  20. Hallstrom name added

    2/11/2025legislature

  21. Notice of hearing for March 03, 2025

    1/29/2025legislature

  22. Referred to Banking, Commerce and Insurance Committee

    1/16/2025legislature

  23. Date of introduction

    1/14/2025legislature

Bill Text

  • Introduced

    1/14/2025

    PDF

  • Enrolled / Slip Law

    PDF

  • Final / Enacted

    PDF

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