Statute 44 4603

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) Covered person means a member, policyholder, subscriber, enrollee, beneficiary, dependent, or other individual participating in a health benefit plan;(4) Director means the Director of Insurance;(5) 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;(6) Health carrier has the same

e 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;(6) Health carrier has the same meaning as in section 44-1303;(7) 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;(8) Pharmacist has the same meaning as in section 38-2832;(9) Pharmacist service means a product, good, or service or any combination thereof provided as a part of the practice of pharmacy;(10) Pharmacy has the same meaning as in section 71-425;(11)(a) Pharmacy benefit manager

ce means a product, good, or service or any combination thereof provided as a part of the practice of pharmacy;(10) Pharmacy has the same meaning as in section 71-425;(11)(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; and(12) Plan sponsor has the same meaning as in section 44-2702.Source Laws 2022, LB767, § 3; Laws 2024, LB1073, § 21. Operative Date: July 19, 2024