§ 44-4603. Terms, defined.

For purposes of the Pharmacy Benefit Manager Licensure and Regulation Act: (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: (a) Receiving a payment for a pharmacist service; or (b) Making a payment to a pharmacist or pharmacy for a pharmacist service; (3) Clinician-administered drug means an outpatient prescription drug other than a vaccine that: (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 (b) Is typically administered: (i) By a health care provider authorized to administer the drug, including when acting under a physician's delegation and supervision; and (ii) In a physician's office, hospital outpatient infusion center, or other clinical setting; (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: (a) Negotiating a rebate, discount, or other financial incentive or arrangement with a drug company; (b) Disbursing or distributing a rebate; (c) Managing or participating in an incentive program or arrangement for a pharmacist service; (d) Negotiating or entering into a contractual arrangement with a pharmacist or pharmacy; (e) Developing and maintaining a formulary; (f) Designing a prescription benefit program; or (g) Advertising or promoting a service; (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; (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 (b) Pharmacy benefit manager does not include: (i) A health care facility licensed in this state; (ii) A health care professional licensed in this state; (iii) A consultant who only provides advice as to the selection or performance of a pharmacy benefit manager; or (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; (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: (a) A pharmacy that specializes in dispensing drugs for patients with rare or complex medical conditions; (b) A pharmacy that specializes in prescription drugs that have specific storage or dispensing requirements; or (c) A pharmacy that holds a specialty pharmacy accreditation from a nationally recognized independent accrediting organization; and (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. History: Laws 2022, LB767, § 3; Laws 2024, LB1073, § 21; Laws 2025, LB198, § 2.