Nebraska Revised Statutes Chapter 44. Insurance § 44-4603. Terms, defined

(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;

(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:

(3)Clinician-administered drug means an outpatient prescription drug other than a vaccine that:

(4)Covered person means a member, policyholder, subscriber, enrollee, beneficiary, dependent, or other individual participating in a health benefit plan;

(5) Director means the Director of Insurance;

(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;

(7) Health carrier has the same meaning as in section 44-1303;

(8)Maintenance medication means a drug prescribed for a chronic, long-term condition and taken on a regular, recurring basis;

(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;

(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;

(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:

(12) Participating provider has the same meaning as in section 44-7103;

(13) Pharmacist has the same meaning as in section 38-2832;

(14)Pharmacist service means a product, good, or service or any combination thereof provided as a part of the practice of pharmacy;

(15) Pharmacy has the same meaning as in section 71-425;

(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;

(18)Pharmacy services administrative organization means an entity that provides a contracted pharmacy with contracting administrative services relating to prescription drug benefits;

(19) Plan sponsor has the same meaning as in section 44-2702;

(20)Specialty pharmacy means:

(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.