Nebraska Revised Statutes Chapter 44. Insurance § 44-4610. Pharmacy benefit manager; specialty pharmacy network; exclusions; specialty pharmacy; terms and conditions

(a) The pharmacy holds a specialty pharmacy accreditation from a nationally recognized independent accrediting organization; and

(b) The pharmacy is willing to accept the terms and conditions of the pharmacy benefit manager's agreement with the pharmacy benefit manager's specialty pharmacies.

(a) Apply terms and conditions to an unaffiliated specialty pharmacy that are stricter than the terms and conditions required for any specialty pharmacy affiliated with the pharmacy benefit manager;

(b) Apply terms and conditions to specialty pharmacies that are inconsistent with the Pharmacy Benefit Manager Licensure and Regulation Act; or

(c) Require data reporting from specialty pharmacies more frequently than quarterly unless reasonably necessary for the pharmacy benefit manager to collect or report data obtained pursuant to subdivision (3)(a) or (b) of this section.

(a) Necessary for a pharmacy benefit manager to meet reporting obligations required by federal or state laws or regulations;

(b) Related to data (i) that may only be obtained from the specialty pharmacy and (ii) that a pharmacy benefit manager is contractually obligated to provide to another entity in order for that entity to meet reporting obligations required by federal or state laws or regulations;

(c) Necessary for purposes of payment integrity or rebate administration; or

(d) Submitted by the specialty pharmacy to the nationally recognized independent accrediting organization from which the specialty pharmacy holds an accreditation.

(a) Policies and metrics related to providing quality and consistent care for patients using the pharmacy; and

(b) Policies and procedures consistent with industry standards to avoid instances of fraud, waste, or abuse.