Nebraska § 44-4610 - Pharmacy benefit manager; specialty pharmacy network; exclusions; specialty pharmacy; terms and conditions.

§ 44-4610. Pharmacy benefit manager; specialty pharmacy network; exclusions; specialty pharmacy; terms and conditions.

(1) A pharmacy benefit manager shall not exclude a Nebraska pharmacy from participation in the pharmacy benefit manager's specialty pharmacy network if:

(a) The pharmacy holds a specialty pharmacy accreditation from a nationally recognized independent accrediting organization; and

(b) The pharmacy is willing to accept the terms and conditions of the pharmacy benefit manager's agreement with the pharmacy benefit manager's specialty pharmacies.

(2) A pharmacy benefit manager shall not:

(a) Apply terms and conditions to an unaffiliated specialty pharmacy that are stricter than the terms and conditions required for any specialty pharmacy affiliated with the pharmacy benefit manager;

(b) Apply terms and conditions to specialty pharmacies that are inconsistent with the Pharmacy Benefit Manager Licensure and Regulation Act; or

(c) Require data reporting from specialty pharmacies more frequently than quarterly unless reasonably necessary for the pharmacy benefit manager to collect or report data obtained pursuant to subdivision (3)(a) or (b) of this section.

(3) A pharmacy benefit manager shall not impose reporting terms and conditions that require a specialty pharmacy to collect and remit data unless such terms and conditions are:

(a) Necessary for a pharmacy benefit manager to meet reporting obligations required by federal or state laws or regulations;

(b) Related to data (i) that may only be obtained from the specialty pharmacy and (ii) that a pharmacy benefit manager is contractually obligated to provide to another entity in order for that entity to meet reporting obligations required by federal or state laws or regulations;

(c) Necessary for purposes of payment integrity or rebate administration; or

(d) Submitted by the specialty pharmacy to the nationally recognized independent accrediting organization from which the specialty pharmacy holds an accreditation.

(4) In addition to other terms and conditions consistent with this section, a pharmacy benefit manager may impose contract terms and conditions that are reasonably necessary to demonstrate that the specialty pharmacy has sufficient:

(a) Policies and metrics related to providing quality and consistent care for patients using the pharmacy; and

(b) Policies and procedures consistent with industry standards to avoid instances of fraud, waste, or abuse.