{"data":{"id":"us-ne/neb.-rev.-stat.-44-4603","jurisdiction":"us-ne","citation":"Neb. Rev. Stat. § 44-4603","heading":"Neb. Rev. Stat. § 44-4603","body":"For purposes of the Pharmacy Benefit Manager Licensure and Regulation Act:\n\n(1) Auditing entity means a pharmacy benefit manager or any person that represents a pharmacy benefit manager in conducting an audit for compliance with a contract between the pharmacy benefit manager and a pharmacy;\n\n(2) Claims processing service means an administrative service performed in connection with the processing and adjudicating of a claim relating to a pharmacist service that includes:\n\n(a) Receiving a payment for a pharmacist service; or\n\n(b) Making a payment to a pharmacist or pharmacy for a pharmacist service;\n\n(3) Clinician-administered drug means an outpatient prescription drug other than a vaccine that:\n\n(a) Cannot reasonably be self-administered by the covered person to whom the drug is prescribed or by an individual assisting the covered person with self-administration; and\n\n(b) Is typically administered:\n\n(i) By a health care provider authorized to administer the drug, including when acting under a physician's delegation and supervision; and\n\n(ii) In a physician's office, hospital outpatient infusion center, or other clinical setting;\n\n(4) Covered person means a member, policyholder, subscriber, enrollee, beneficiary, dependent, or other individual participating in a health benefit plan;\n\n(5) Director means the Director of Insurance;\n\n(6) Health benefit plan means a policy, contract, certificate, plan, or agreement entered into, offered, or issued by a health carrier or self-funded employee benefit plan to the extent not preempted by federal law to provide, deliver, arrange for, pay for, or reimburse any of the costs of a physical, mental, or behavioral health care service;\n\n(7) Health carrier has the same meaning as in section 44-1303 ;\n\n(8) Maintenance medication means a drug prescribed for a chronic, long-term condition and taken on a regular, recurring basis;\n\n(9) Network pharmacist means a pharmacist that has a contract, either directly or through a pharmacy services administrative organization, with a pharmacy benefit manager to provide covered drugs at a negotiated reimbursement rate;\n\n(10) Network pharmacy means a pharmacy that has a contract, either directly or through a pharmacy services administrative organization, with a pharmacy benefit manager to provide covered drugs at a negotiated reimbursement rate;\n\n(11) Other prescription drug or device service means a service other than a claims processing service, provided directly or indirectly, whether in connection with or separate from a claims processing service, including, but not limited to:\n\n(a) Negotiating a rebate, discount, or other financial incentive or arrangement with a drug company;\n\n(b) Disbursing or distributing a rebate;\n\n(c) Managing or participating in an incentive program or arrangement for a pharmacist service;\n\n(d) Negotiating or entering into a contractual arrangement with a pharmacist or pharmacy;\n\n(e) Developing and maintaining a formulary;\n\n(f) Designing a prescription benefit program; or\n\n(g) Advertising or promoting a service;\n\n(12) Participating provider has the same meaning as in section 44-7103 ;\n\n(13) Pharmacist has the same meaning as in section 38-2832 ;\n\n(14) Pharmacist service means a product, good, or service or any combination thereof provided as a part of the practice of pharmacy;\n\n(15) Pharmacy has the same meaning as in section 71-425 ;\n\n(16)(a) Pharmacy benefit manager means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefit manager, that provides a claims processing service or other prescription drug or device service for a health benefit plan to a covered person who is a resident of this state; and\n\n(b) Pharmacy benefit manager does not include:\nsection 71-425 ;\n\n(16)(a) Pharmacy benefit manager means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefit manager, that provides a claims processing service or other prescription drug or device service for a health benefit plan to a covered person who is a resident of this state; and\n\n(b) Pharmacy benefit manager does not include:\n\n(i) A health care facility licensed in this state;\n\n(ii) A health care professional licensed in this state;\n\n(iii) A consultant who only provides advice as to the selection or performance of a pharmacy benefit manager; or\n\n(iv) A health carrier to the extent that it performs any claims processing service or other prescription drug or device service exclusively for its enrollees;\n\n(17) Pharmacy benefit manager affiliate means a pharmacy or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership or control with a pharmacy benefit manager;\n\n(18) Pharmacy services administrative organization means an entity that provides a contracted pharmacy with contracting administrative services relating to prescription drug benefits;\n\n(19) Plan sponsor has the same meaning as in section 44-2702 ;\n\n(20) Specialty pharmacy means:\n\n(a) A pharmacy that specializes in dispensing drugs for patients with rare or complex medical conditions;\n\n(b) A pharmacy that specializes in prescription drugs that have specific storage or dispensing requirements; or\n\n(c) A pharmacy that holds a specialty pharmacy accreditation from a nationally recognized independent accrediting organization; and\n\n(21) Spread pricing means the method of pricing a drug in which the contracted price for a drug that a pharmacy benefit manager charges a health benefit plan differs from the amount the pharmacy benefit manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services.","path":["NE Code","Chapter 44"],"source_url":"https://nebraskalegislature.gov/laws/statutes.php?statute=44-4603","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:21Z","sha256":"4c6f50a82441fa3e4d234a999d7e4b4c9392c5608c33b9b97c30037f68320db7","source_id":"us-ne","stale":false,"prev":"us-ne/neb.-rev.-stat.-44-4602","next":"us-ne/neb.-rev.-stat.-44-4604"},"notice":"GroundRules: Original legal text. Not legal advice."}