LB198 revises the Pharmacy Benefit Manager Licensure and Regulation Act and makes a series of changes aimed at regulating how pharmacy benefit managers (PBMs), health carriers, and health benefit plans interact with Nebraska pharmacies and patients. The bill defines and clarifies several terms, including specialty pharmacy, network pharmacy, network pharmacist, clinician-administered drug, spread pricing, and other prescription drug or device services. It also updates the statutory framework governing PBM licensure and conduct, and repeals the original sections being replaced.
A major focus of the bill is limiting PBM and health plan practices that can restrict pharmacy participation or steer patients to particular pharmacies. LB198 prohibits PBMs from excluding Nebraska specialty pharmacies from specialty pharmacy networks if they meet accreditation and contract terms, and bars PBMs from imposing stricter or inconsistent terms on unaffiliated specialty pharmacies. It also restricts PBMs and health carriers from requiring exclusive use of mail-order or affiliated pharmacies, from penalizing pharmacies or providers for declining to source drugs through a selected specialty pharmacy in certain circumstances, and from using financial incentives that favor PBM-affiliated pharmacies. The bill further prohibits spread pricing in PBM contracts issued on or after January 1, 2026, and limits the use of spread pricing in existing contracts after that date.
The bill also addresses clinician-administered drugs, especially those dispensed through specialty pharmacies. It requires specialty pharmacies shipping these drugs to comply with federal shipping and track-and-trace rules, provide access to pharmacists or nurses, allow refill requests under utilization review procedures, and disclose delivery timing information. It bars PBMs and health carriers from forcing patients to receive a clinician-administered drug through a specialty pharmacy when a participating provider can source and administer the drug at substantially similar cost, and it creates an appeal/exception process when delivery problems occur or when immediate treatment is medically necessary.
LB198 also protects retail pharmacy delivery services by preventing PBM contracts from banning pharmacies from offering mail or common-carrier delivery to patients, while allowing pharmacies to disclose delivery fees and clarifying that plans are not required to reimburse those fees. In addition, the bill prevents PBMs and health plans from requiring patients to use only mail-order services, from transferring prescriptions without patient request, and from auto-enrolling patients in mail-order services except under limited conditions for maintenance medications. It also bars PBMs from retaliating against network pharmacies that decline to provide drugs when reimbursement is below acquisition cost, and it eliminates spread pricing in future PBM-health plan contracts.
Overall, the bill’s impact is to tighten state oversight of PBM practices, expand protections for independent and Nebraska-based pharmacies, and increase patient and provider flexibility in obtaining prescription drugs and clinician-administered therapies. The sentiment reflected in the voting history was strongly favorable and bipartisan: the bill and its amendments advanced unanimously through the Legislature and passed final reading 49-0, indicating broad support for the regulatory changes. The main points of contention, based on the bill’s structure rather than recorded debate, are the restrictions on PBM business practices—especially spread pricing, network steering, specialty pharmacy contracting, and reimbursement rules—which would likely be opposed by PBMs, some health carriers, and affiliated pharmacy interests, while being supported by independent pharmacies, providers, and patient-access advocates.
LB198 amends the Pharmacy Benefit Manager Licensure and Regulation Act and related statutes to regulate PBM contracting, network access, specialty pharmacy participation, delivery practices, and pricing methods. It creates new definitions and operative rules that affect PBMs, health carriers, health benefit plans, retail pharmacies, specialty pharmacies, pharmacists, providers administering clinician-administered drugs, and covered persons. The bill also repeals the original sections it replaces and sets a future effective date for the new restrictions, including a ban on spread pricing in new contracts and limits on existing contracts after January 1, 2026.
The bill appears to have had very strong support in the Legislature. The recorded votes were unanimous or near-unanimous at each stage, culminating in final passage 49-0. With no committee transcript excerpts available, the available voting history suggests broad bipartisan agreement that the bill addresses perceived problems in PBM practices and pharmacy access.
The likely areas of contention are the bill’s limits on PBM and health plan control over pharmacy networks and reimbursement. PBMs and their affiliates may object to the prohibition on spread pricing, restrictions on excluding Nebraska specialty pharmacies, limits on mail-order steering and auto-enrollment, and the ban on retaliating against pharmacies that decline under-reimbursed prescriptions. By contrast, independent pharmacies, specialty pharmacies, providers, and patient-access advocates are the groups most likely to support these provisions because they reduce network leverage and expand patient choice and local pharmacy access.