Banking, Commerce and Insurance Committee
March 3, 2025
Committee Chair: Sen. Mike Jacobson | Bills Heard: 3 | Full Transcript (PDF)
LB198: Pharmacy Benefit Manager Reform
Introduced by: Sen. Tony Sorrentino | Testimony: 8 proponents, 4 opponents, 0 neutral | Read bill text (PDF)
Nebraska advances major pharmacy benefit manager reform targeting spread pricing and below-cost reimbursements. LB198 would prohibit PBMs from steering patients to affiliated pharmacies, require fair reimbursement above acquisition costs, and ban spread pricing—practices that have contributed to the closure of 69 Nebraska pharmacies since 2020.
Why it matters: Rural and urban communities are losing access to local pharmacies as PBMs use below-cost reimbursements and patient steering to drive business to their own mail-order operations. The bill addresses a real crisis: some Nebraska counties now have zero pharmacies, forcing residents to drive 20+ miles for medications.
What they're saying: - Proponents: "We don't want to turn patients away. We just want to be paid a fair price," said independent pharmacy owner David Randolph. The FTC has found $1.4 billion in spread income and $7.3 billion in markup pricing by the Big 3 PBMs. Twenty-nine states have already enacted spread pricing bans. - Opponents: PBMs argue the bill guarantees profits and removes incentive for pharmacies to seek lowest wholesale prices. PCMA's Bill Head said spread pricing is a contractual choice by health plans, not imposed by PBMs, and questioned whether the bill addresses the real culprit: high drug manufacturer prices.
By the numbers: 69 pharmacy closures since 2020; 35% of trade name prescriptions reimbursed below cost at some pharmacies; 80% of prescription drug coverage managed by three PBMs.
What's next: No vote was taken. The bill remains in committee with significant support from pharmacy groups and hospitals but opposition from PBMs and insurers. Sen. Jacobson emphasized the need to "get it right" given the complexity of the pharmaceutical supply chain.
Committee sentiment: Supportive: Sen. Hallstrom, Sen. Bostar Skeptical: Sen. Riepe, Sen. Jacobson Unclear: Sen. von Gillern
Sentiment estimated from questions and comments — not stated positions.
LB158: Copay Accumulator Adjustment Programs
Introduced by: Sen. Dave Wordekemper | Testimony: 4 proponents, 4 opponents, 0 neutral | Read bill text (PDF)
Nebraska considers banning 'accumulator adjustment programs' that force patients to pay deductibles twice. LB158 would require health insurers to count third-party copay assistance toward patients' deductibles and out-of-pocket maximums, addressing a practice where insurers collect manufacturer assistance while still requiring patients to meet their full deductibles.
Why it matters: Patients with hemophilia, cancer, and other rare diseases face impossible choices when accumulator programs eliminate copay assistance after a few months, leaving them responsible for $5,000-$10,000 deductibles on top of $300,000+ annual medication costs. Non-compliance leads to joint damage, disability, and emergency room visits that cost far more.
What they're saying: - Proponents: "My son's medication costs $300,000 a year with an $800 copay per dose. Without assistance, he faces life-threatening bleeding," testified Dale Gibbs. One mother described her 13-year-old's copay jumping from $294 to $10,000 monthly. Research shows poor medication adherence costs the U.S. healthcare system $528 billion annually. - Opponents: Insurers argue copay assistance incentivizes expensive brand-name drugs over generics and that federal anti-kickback laws prohibit such assistance in Medicare for good reason. They distinguish manufacturer assistance (which has financial incentives) from family assistance.
By the numbers: 21 states have enacted similar protections; hemophilia medications cost $300,000+ annually; one patient faced $120,000 annual copays with no out-of-pocket maximum.
What's next: No vote was taken. The bill remains in committee with strong emotional testimony from families but significant opposition from insurers concerned about cost increases and moral hazard.
Committee sentiment: Supportive: Sen. Dungan Skeptical: Sen. Riepe, Sen. Jacobson Unclear: Sen. Hallstrom
Sentiment estimated from questions and comments — not stated positions.
LB533: White Bagging Guidelines for Specialty Pharmacy Drugs
Introduced by: Sen. Kathleen Kauth | Testimony: 3 proponents, 1 opponents, 0 neutral | Read bill text (PDF)
Nebraska proposes guidelines for 'white bagging' specialty pharmacy drugs, balancing cost savings against hospital safety concerns. LB533 would establish requirements for health insurers sourcing clinician-administered drugs from specialty pharmacies, including federal compliance, 24/7 access, advance notice, and appeal processes for failed deliveries.
Why it matters: White bagging can save thousands monthly on expensive drugs—one example showed $2,000 monthly savings on Crysvita—but hospitals worry about medication delays, dosing errors, and lack of emergency inventory. The bill attempts to preserve savings while addressing legitimate safety concerns.
What they're saying: - Proponents: "Hospitals have charged unreasonable markups, including over $6 million on a drug with a $2.4 million list price," testified Blue Cross. The bill ensures proper handling while maintaining access for rural patients who lack capacity to stock expensive drugs. - Opponents: "The bill doesn't provide adequate safeguards for weight-dependent dosing or address what happens when medications don't arrive," said hospital pharmacist Elizabeth Boals-Shively. She described spending 2 hours across 5 different people just to track a prescription and noted hospitals cannot afford emergency inventory.
By the numbers: One example showed $2,000 monthly savings on Crysvita; hospitals sometimes mark up drugs 3-5 times compared to specialty pharmacy costs.
What's next: No vote was taken. Senator Kauth indicated willingness to work with the Nebraska Hospital Association on language refinements. The bill remains in committee with support from insurers and patient advocates but concerns from hospitals about implementation details and safety safeguards.
Committee sentiment: Unclear: Sen. von Gillern, Sen. Hallstrom
Sentiment estimated from questions and comments — not stated positions.
Session Notes
The committee heard three bills on March 3, 2025. Committee Chair Sen. Mike Jacobson opened with procedural instructions regarding testifier sheets, time limits (3-minute green light system), and written position submission deadlines. Committee members present included Sens. Merv Riepe, Brad von Gillern, Elliot Bostar, Bob Hallstrom, Dave Wordekemper, and George Dungan. Legal counsel Joshua Cristolear and committee clerk Natalie Schunk assisted. Pages Ayden Topping and Kathryn Singh were introduced. A blizzard warning was mentioned during testimony, with one early testifier needing to depart to avoid weather. Sen. Jacobson left during LB158 to present a bill in another committee, and Sen. Hallstrom assumed the chair for the remainder of the hearing. No votes were taken on any bills during this hearing.
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