Change the Pharmacy Benefit Manager Licensure and Regulation Act. LB 778 specifically amends activities regulated under the Act to include the following:
• Prohibit spread pricing and require all PBM contracts to be amended to expressly state spread pricing is prohibited under the Act.
• Require a PBM to pay a pharmacy the acquisition cost if the maximum allowable cost price (MAC) is below the wholesaler cost, if that is the wholesaler used to purchase the majority of the pharmacy’s resale pharmaceuticals.
• Requires the maximum allowable cost price be adjusted to the acquisition cost for each similarly situated pharmacy;
• Prohibits a PBM from requiring a pharmacy to meet accreditation standards or recertification requirements more stringent than the minimum state and federal requirements for licensure.
• Requires a PBM to reimburse a pharmacy at the same rate it reimburses an affiliated pharmacy for a pharmacy service and expressly prohibits patient-steering to an affiliate of the PBM.
• Creates duties of a PBM to any covered person, health benefit plan, or provider/pharmacy. The order in cases of conflicts is to the
duty of the covered person, the provider, and then the health plan.