44-4606. Participation contract; requirements; disclosure of information; limitations; contract termination; grounds; pharmacy benefit manager, prohibited acts.
470 words·~2 min read·
/ne/chapter-44/44-4606A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)A participation contract between a pharmacy benefit manager and any pharmacist or pharmacy providing prescription drug coverage for a health benefit plan shall not prohibit or restrict any pharmacy or pharmacist from or penalize any pharmacy or pharmacist for disclosing to any covered person any health care information that the pharmacy or pharmacist deems appropriate regarding:
(a)The nature of treatment, risks, or an alternative to such treatment;
(b)The availability of an alternate therapy, consultation, or test;
(c)The decision of a utilization reviewer or similar person to authorize or deny a service;
(d)The process that is used to authorize or deny a health care service or benefit; or
(e)Information on any financial incentive or structure used by the health carrier.
(2)A pharmacy benefit manager shall not prohibit a pharmacy or pharmacist from discussing information regarding the total cost for a pharmacist service for a prescription drug or from selling a more affordable alternative to the covered person if a more affordable alternative is available.
(3)A pharmacy benefit manager contract with a participating pharmacist or pharmacy shall not prohibit, restrict, or limit disclosure of information to the director, law enforcement, or a state or federal governmental official, provided that:
(a)The recipient of the information represents that such recipient has the authority, to the extent provided by state or federal law, to maintain proprietary information as confidential; and
(b)Prior to disclosure of information designated as confidential, the pharmacist or pharmacy:
(i)Marks as confidential any document in which the information appears; or
(ii)Requests confidential treatment for any oral communication of the information.
(4)A pharmacy benefit manager shall not terminate the contract with or penalize a pharmacist or pharmacy due to the pharmacist or pharmacy:
(a)Disclosing information about a pharmacy benefit manager practice, except information determined to be a trade secret, as determined by state law or the director; or
(b)Sharing any portion of the pharmacy benefit manager contract with the director pursuant to a complaint or a query regarding whether the contract is in compliance with the Pharmacy Benefit Manager Licensure and Regulation Act.
(5)(a) A pharmacy benefit manager shall not require a covered person purchasing a covered prescription drug to pay an amount greater than the lesser of the covered person's cost-sharing amount under the terms of the health benefit plan or the amount the covered person would pay for the drug if the covered person were paying the cash price.
(b)Any amount paid by a covered person under subdivision (5)(a) of this section shall be attributable toward any deductible or, to the extent consistent with section 2707 of the federal Public Health Service Act, 42 U.S.C. 300gg-6, as such section existed on January 1, 2022, the annual out-of-pocket maximum under the covered person's health benefit plan.