Nebraska § 44-4608 Contract; pharmacy benefit manager; cost price list; duties; disputes; procedures

Nebraska Statutes

§ 44-4608 — Contract; pharmacy benefit manager; cost price list; duties; disputes; procedures

Nebraska·Ch. 44 Insurance

(1)With respect to each contract and contract renewal between a pharmacy benefit manager and a pharmacy, the pharmacy benefit manager shall:

(a)Update any maximum allowable cost price list at least every seven business days, noting any price change from the previous list, and provide a means by which a network pharmacy may promptly review a current price in an electronic, print, or telephonic format within one business day of any such change at no cost to the pharmacy;

(b)Maintain a procedure to eliminate a product from the maximum allowable cost price list in a timely manner to remain consistent with any change in the marketplace; and

(c)Make the maximum allowable cost price list available to each contracted pharmacy in a format that is readily accessible and usable to the contracted

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(1) With respect to each contract and contract renewal between a pharmacy benefit manager and a pharmacy, the pharmacy benefit manager shall:
(a) Update any maximum allowable cost price list at least every seven business days, noting any price change from the previous list, and provide a means by which a network pharmacy may promptly review a current price in an electronic, print, or telephonic format within one business day of any such change at no cost to the pharmacy;
(b) Maintain a procedure to eliminate a product from the maximum allowable cost price list in a timely manner to remain consistent with any change in the marketplace; and
(c) Make the maximum allowable cost price list available to each contracted pharmacy in a format that is readily accessible and usable to the contracted pharmacy.
(2) A pharmacy benefit manager shall not place a prescription drug on a maximum allowable cost price list unless the drug is available for purchase by pharmacies in this state from a national or regional drug wholesaler and is not obsolete.
(3) Each contract between a pharmacy benefit manager and a pharmacy shall include a process to appeal, investigate, and resolve disputes regarding any maximum allowable cost price. The process shall include:
(a) A fifteen-business-day limit on the right to appeal following submission of an initial claim by a pharmacy;
(b) A requirement that any appeal be investigated and resolved within seven business days after the appeal is received by the pharmacy benefit manager; and
(c) A requirement that the pharmacy benefit manager provide a reason for any denial of an appeal and identify the national drug code for the drug that may be purchased by the pharmacy at a price at or below the price on the maximum allowable cost price list as determined by the pharmacy benefit manager.
(4) If an appeal is determined to be valid by the pharmacy benefit manager, the pharmacy benefit manager shall:
(a) Make an adjustment in the drug price no later than one day after the appeal is resolved; and
(b) Permit the appealing pharmacy to reverse and rebill the claim in question, using the date of the original claim.

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