Banking, Commerce and Insurance Committee
February 10, 2025
Committee Chair: Sen. Mike Jacobson | Bills Heard: 4 | Full Transcript (PDF)
LB77: Ensuring Transparency in Prior Authorization Act
Introduced by: Sen. Eliot Bostar | Testimony: 10 proponents, 3 opponents, 0 neutral | Read bill text (PDF)
Nebraska advances sweeping prior authorization reform to protect patients from insurance delays. Sen. Bostar's LB77 would require health insurers to respond to authorization requests within days, prohibit AI-only denials, and mandate physician-level review of rejections—addressing a system where 83% of Medicare Advantage denials are overturned on appeal.
Why it matters: Patients with cancer, rheumatoid arthritis, and other serious conditions face 7-14 day delays starting treatment while insurers review requests. Physicians spend 14+ hours weekly on prior auth paperwork. One oncologist testified a patient died after a 12-day delay waiting for approval of a recommended drug.
What they're saying: - Proponents: "Prior authorization delays access to necessary care and has a negative impact on patient clinical outcomes," Dr. Mary Wells testified. Hospital CEO Ivan Mitchell described a patient stuck in the hospital 10+ weeks awaiting rehab approval, with an insurer using an AI tool with a 90% error rate. - Opponents: Blue Cross Blue Shield said it's already voluntarily improving processes and asked for time to implement changes. Insurance Federation warned the bill could create confusion if it diverges from federal rules.
By the numbers: 37 proponent letters; 0 opponent letters; 95% of physicians report prior auth increases burnout; 87% say it drives up overall health care costs.
What's next: No vote taken. Sen. Bostar indicated willingness to hold the bill on final reading until Q1 ends if insurers need time to complete voluntary reforms, allowing committee to advance it to General File.
Committee sentiment: Supportive: Sen. Hallstrom, Sen. Riepe, Sen. Dungan, Sen. Hardin
Sentiment estimated from questions and comments — not stated positions.
LB467: Prior Authorization API Implementation
Introduced by: Sen. Merv Riepe | Testimony: 2 proponents, 0 opponents, 0 neutral | Read bill text (PDF)
Nebraska moves to align prior authorization technology with federal standards. Sen. Riepe's LB467 would require health insurers to adopt API technology for processing prior authorization requests by January 1, 2028, matching federal rules already mandated for Medicare Advantage and Medicaid plans.
Why it matters: Electronic API submission reduces miscommunication, clerical errors, and administrative burden on providers. Creates uniform process across all payer types so providers don't navigate different systems for each insurer.
What they're saying: - Proponents: Insurance Federation and Blue Cross Blue Shield both supported the bill as necessary for uniformity. "Aligning state law with federal requirements would likely encourage health insurers and ERISA plan sponsors to adopt the same requirements, creating a uniform process," Blake testified.
By the numbers: 3 proponent letters; 0 opponent letters; federal rule effective January 1, 2027; bill sets state implementation for January 1, 2028.
What's next: No vote taken. Bill heard without opposition from insurance industry.
Committee sentiment: Supportive: Sen. Hallstrom, Sen. Riepe
Sentiment estimated from questions and comments — not stated positions.
LB457: Anaphylaxis Preparedness and EpiPen Cost Cap
Introduced by: Sen. Eliot Bostar | Testimony: 6 proponents, 0 opponents, 1 neutral | Read bill text (PDF)
Nebraska moves to make life-saving allergy medication affordable for families. Sen. Bostar's LB457 caps out-of-pocket costs for epinephrine auto-injectors at $60 per two-pack and requires schools and child care programs to adopt standardized anaphylaxis response policies.
Why it matters: Nearly 200,000 Nebraskans have food allergies. EpiPens cost $650-$750 without insurance; families with high-deductible plans pay thousands annually. Anaphylaxis can be fatal within minutes. One 2022 death in Papillion-La Vista occurred because a student didn't receive epinephrine in time.
What they're saying: - Proponents: "We should never allow financial barriers to determine whether a child lives or dies," pediatric allergist Dr. Hana Niebur testified. Parent Katherine White said the annual $1,400 cost for two packs equals 88.2% of the median Nebraska mortgage payment. - Neutral: Insurance Federation acknowledged EpiPens are life-saving but said it generally opposes health care mandates. However, it worked with Bostar to include HSA-compatible language.
By the numbers: 36,000 Nebraska children have food allergies; 11% of schools report at least one anaphylaxis episode annually; EpiPen shelf life is about one year; 8 proponent letters; 1 opponent letter; 0 neutral testifiers.
What's next: No vote taken. Fiscal note shows zero cost to state because existing regulations already require anaphylaxis plans; bill clarifies and expands those requirements.
Committee sentiment: Supportive: Sen. Dungan, Sen. Hallstrom Skeptical: Sen. Riepe Unclear: Sen. von Gillern
Sentiment estimated from questions and comments — not stated positions.
LB109: Pharmacy Benefit Manager Regulation
Introduced by: Sen. Eliot Bostar | Testimony: 6 proponents, 4 opponents, 0 neutral | Read bill text (PDF)
Nebraska considers cracking down on pharmacy benefit manager practices that delay patient care. Sen. Bostar's LB109 would prohibit PBMs from mandating white bagging (requiring medications be shipped from PBM specialty pharmacies) and from imposing unreasonable contract terms that exclude independent pharmacies from networks.
Why it matters: White bagging causes medication delays, supply chain disruptions, and forces patients to travel long distances for care. PBMs control 85% of the insured market and use that power to exclude non-affiliated pharmacies. Rural patients lose mail delivery options when PBMs restrict local pharmacies.
What they're saying: - Proponents: "This is an extremely inefficient and risky workflow," Boys Town testified, describing cases where white-bagged medications never arrived, forcing hospitals to absorb $22,000 costs. Rheumatologist Dr. Amy Garwood described a lupus patient who ended up back in the hospital on dialysis after white bagging prevented timely infusion. - Opponents: Blue Cross Blue Shield said hospitals mark up drugs 3-6 times specialty pharmacy costs, and the bill would steer all care to hospitals, raising premiums. PBM Prime Therapeutics noted specialty pharmacies have 99%+ accuracy and questioned whether retail pharmacies mailing drugs would comply with licensing requirements.
By the numbers: 11 proponent letters; 0 opponent letters; 3 PBMs control 85% of insured market; specialty pharmacies achieve 99%+ delivery accuracy per URAC reports; 97% customer satisfaction.
What's next: No vote taken. Chair Jacobson indicated intention to hold interim study hearings next summer to bring all parties together, including pharmaceutical manufacturers who set drug prices.
Committee sentiment: Supportive: Sen. Hallstrom, Sen. Dungan, Sen. Hardin Skeptical: Sen. Riepe Unclear: Sen. von Gillern, Sen. Wordekemper
Sentiment estimated from questions and comments — not stated positions.
Session Notes
Committee heard four bills on February 10, 2025. Chair Jacobson noted at conclusion that committee will not hold executive session tonight but has amendment on 340B program to address. Chair indicated intention to hold interim study hearings next summer on PBM issues to bring together medical providers, insurance companies, and pharmaceutical manufacturers. Sen. Hallstrom left hearing early to attend another commitment. Committee received written testimony: LB77 (37 proponent, 0 opponent, 2 neutral letters); LB467 (3 proponent, 0 opponent, 0 neutral); LB457 (8 proponent, 1 opponent, 0 neutral); LB109 (11 proponent, 0 opponent, 0 neutral). No votes were taken on any bills during the hearing.
Generated by NE Wire Service | Source: Nebraska Legislature Transcribers Office This is an AI-generated summary. Verify all claims against the official transcript.