[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6335345,"mediaKeyId","2289709-f0c4c084bf040d7f91879a7e669920e0","parentId",2289709,"title","Lawmakers hear debate on LB109 to limit PBM steering, restrict white‑bagging and protect local pharmacies","audioSeconds",819,"startMs",10749000,"endMs",11568000,"viewUrl","/Search/View?dp=1&key=2289709-f0c4c084bf040d7f91879a7e669920e0&start=10749&end=11568","thumbnailUrl","https://assets.pipeline.soar.com/2289709-f0c4c084bf040d7f91879a7e669920e0/thumbnail_10749000.jpg","articleUrl","/articles/6335345/Nebraska/Lawmakers-hear-debate-on-LB109-to-limit-PBM-steering-restrict-whitebagging-and-protect-local-pharmacies","mediaUrl","https://secure.pipeline.soar.com/6335345-8cc62830df7c4b97d765e5a90ca17788/orig.mp4?Expires=1776153868&Signature=nUMVWgOw5xa5rhbTf2mcuzFnePUul-~QisSQIEnTll-DUPoYI4WfGzg4z5MG1tw3HnCp1j-X9M12XJBH8zEkUULlcntNPSsSPz1oYBuQZ0YVeKHFL7yKvrWWzFmoWW0GuN8qO1IcYBSxE5RH8FOh6HF6lwcDcCNLMXnSDiWGWu-7nLLzUeQjXZERvwUzxMwu8e9K2rTDy8kK1qJuxAUyaZtdQ2ayPkLzOCkCIkM7-N8m76BvaWRSYn14RPgRrBKw7xI~cbF1Ilufb2GfAx36TJlzldyAfXMMg3LnsH4siMhu8eBPYEKKgUO0n8hHNVQeilwW8kdQlNbg~50yZ9zPIA__&Key-Pair-Id=KUT5TJCACFTXG","author","Nebraska Legislature","date","2025-02-10T00:00:00Z","article","LB109, introduced by Senator Elliot Bostar, would prohibit pharmacy benefit managers (PBMs) from requiring \"white bagging\" (a practice in which a PBM’s specialty pharmacy ships a medication directly to a hospital or clinic for clinician administration) and would stop PBMs from restricting retail pharmacies' chosen methods of dispensing and delivery. The bill would also require that nationally accredited Nebraska specialty pharmacies be allowed to participate in PBM specialty networks under reasonable contract terms.

Supporters — including hospital systems, infusion nurses, pharmacists at critical‑access hospitals, specialty clinicians and families — described repeated patient-care disruptions, delayed infusions, administrative waste and coverage disputes that they tied to PBM steering and white‑bagging mandates.

\"This is an extremely inefficient and risky workflow,\" said Andrew Raduchel, director of Boys Town National Research Hospital, who walked the committee through a comparative workflow between the hospital‑administered model and white‑bagging. Multiple nurses and small‑hospital pharmacy managers testified that white‑bagging shipments arrive late, arrive to the wrong place, or require discarding costly doses that cannot be returned, causing rescheduled care and financial risk for small providers. \"When a specialty medication does not show up,\" an infusion director said, \"we just don't infuse it.\" Several witnesses said they had absorbed notable unreimbursed pharmacy costs after providing treatment when PBM‑supplied doses did not arrive.

Physicians described effects on clinical decision‑making and safety. \"White‑bagging can cause serious, potentially harmful disruptions to patient care,\" Senator Bostar said in his opening; clinicians gave examples of delayed biologic therapy, lost continuity of care and dosing changes that were difficult to manage when a dose arrives from an external specialty pharmacy.

PBMs and insurers opposed portions of the bill or asked for different approaches. Blue Cross and Blue Shield of Nebraska and Prime Therapeutics argued that PBM credentialing and accreditation processes (URAC and similar standards) already secure delivery safety and quality, and that PBMs negotiate lower net prices and manage specialty distribution to control cost. They warned the bill could increase costs by steering care into higher‑priced settings. Insurers also noted that ERISA‑governed, self‑funded plans and some other plan types may be outside state authority.

Committee members questioned reimbursement levels, site‑of‑care effects (clinic vs. hospital pricing), supply‑chain tracking, and the interplay with federal programs. Witnesses on both sides agreed PBM contracting, rebates and vertical integration make a complex system where a mix of pricing incentives, patient‑safety issues and administrative friction intersects.

The hearing produced extensive proponent testimony and several opponents; committee action was not recorded in the transcript excerpt.","mediaType","Video","parentTitle","Banking, Commerce and Insurance 02/10/2025","oneSentenceSummary","LB109 would ban certain PBM practices including compulsory white‑bagging, prevent PBMs from restricting how retail pharmacies deliver medications, and require accredited Nebraska pharmacies be eligible for specialty networks.","taxTitle","2025 Legislature NE, Nebraska","taxId",77675,"location","Nebraska","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6335350,"Nebraska bill would standardize school and childcare anaphylaxis policies, cap EpiPen copays at $60",3384,7422000,10806000,"/Search/View?dp=1&key=2289709-f0c4c084bf040d7f91879a7e669920e0&start=7422&end=10806","https://assets.pipeline.soar.com/2289709-f0c4c084bf040d7f91879a7e669920e0/thumbnail_7422000.jpg","/articles/6335350/Nebraska/Nebraska-bill-would-standardize-school-and-childcare-anaphylaxis-policies-cap-EpiPen-copays-at-60","https://secure.pipeline.soar.com/6335350-740d21253d025300ffcf0b2d77ed729a/orig.mp4?Expires=1776153868&Signature=lk5q23NdgPDfOUJRhRNsAwFK6FOLRRq20bd5hh-kQl4Q93O-UQU-Hy7zAiYJSTlegn6wlABCKyJBoAvKVoZ2qx4CWwn3ufCRG~U3EI7aJzWucZSPJDBIxBa7sMQMCiYW6X8eeUgkJ50zktrVAXihmcu0lwH3A4a7iq5qdH6Wj~gt4qgYZrvJgVgzKNt~y-YtM-Kdshif7IoY~NfEzYI5qBklhQf97WKJ~BsiQiz0b20hDuC3hkWeQGXeqmQkaQU3sEng~o6odNFwpUMs5zrdw4o~H-Qede-hHuxQPHUC2qS9FMsHuUuanUE~3sbSG9lVhn2JVzrz-vWQbE25cKty1Q__&Key-Pair-Id=KUT5TJCACFTXG","Note: shortSummary truncated in schema field accidentally in drafting; full article follows.

Lawmakers heard testimony on LB457, sponsored by Senator Elliot Bostar, which would require the Department of Health and Human Services (DHHS), in consultation with the State Department of Education, to develop model anaphylaxis policies for school districts and licensed childcare programs and cap patient out‑of‑pocket costs for epinephrine auto‑injectors at $60 for a two‑pack for covered individuals.

\"Anaphylaxis is a severe and potentially life threatening allergic reaction that requires immediate medical intervention,\" Senator Bostar said, describing the proposal to standardize prevention, response and communication for anaphylaxis in schools and childcare settings.

Physicians and childcare providers testified about the clinical urgency and caregiving complexity. \"Without immediate access to epinephrine, anaphylaxis can be fatal,\" Dr. Hana Niebuhr, a pediatric allergist, said, urging the committee to pass LB457 so schools and childcare centers will have consistent, medically sound guidance. Parents described the financial strain of replacing auto‑injectors annually and carrying multiple sets for school and home. \"Because of this, we have to carry 2 EpiPens with us everywhere we go,\" said Katherine White, mother of a child with peanut and tree‑nut allergies.

Supporters pointed to steep retail costs; testimony referenced branded and generic price ranges from several hundred to several thousand dollars for a year's supply, and stressed shelf life of roughly one year for most auto‑injectors. Senator Bostar and witnesses compared the situation to prior state and federal consumer protections for essential medications and highlighted the human-safety risk when families cannot afford replacements.

Insurance representatives and the Nebraska Insurance Federation testified in a neutral/qualified manner and noted legal and tax implications for health‑savings accounts (HSAs) and high‑deductible health plans; the federation worked with the sponsor on language intended to preserve HSA eligibility. Witnesses also said that many plans already cap or waive copays for auto‑injectors, and urged careful drafting to avoid unintended consequences for HSA-qualified plans.

The transcript records extensive proponent testimony and no formal committee action during the recorded portion. The bill would not require the state to purchase or stock epinephrine; rather, it would require model policies for covered programs and cap covered individual cost-sharing for EpiPen two‑packs at $60 for applicable plans and enrollees.

Ending note: The committee received emotional and detailed firsthand testimony from parents, physicians, and childcare directors asserting that cost and lack of standard policy can create real safety risks for children with severe allergies.","LB457 would require statewide model anaphylaxis policies for schools and licensed childcare programs and cap out‑of‑pocket costs at $60 for a two‑pack of epinephrine auto‑injectors for covered individuals.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6335355,"Bill would require prior-authorization API for Nebraska commercial plans to match federal standards",364,6794000,7158000,"/Search/View?dp=1&key=2289709-f0c4c084bf040d7f91879a7e669920e0&start=6794&end=7158","https://assets.pipeline.soar.com/2289709-f0c4c084bf040d7f91879a7e669920e0/thumbnail_6794000.jpg","/articles/6335355/Nebraska/Bill-would-require-prior-authorization-API-for-Nebraska-commercial-plans-to-match-federal-standards","https://secure.pipeline.soar.com/6335355-cd348e074fe1570f45145730af4a0e17/orig.mp4?Expires=1776153868&Signature=CdbnD~MG1b7wU4mDWqhythm5TGzBENv4G-2a-Xs9XuI~VlsbZA2zt5bk2BUmHkUox0i0PvqLvFSAPCY8TwS~sUN1RIIgjIgVmMcwjjwWt1ZtZ2vrczeJiaOWox2LnOMGYjIjwjiKMEPMc-v5mlr0L1uJKdZJbDgB28lXEjGapfbzYOfhqyCeKVXziY1uqIhHt7BU9eR1nHyMAcKYShniK95znQJOMiIcJVQsxnwZQX3VXCZB2XtZlPYNFEYRzpBfZtfpdPEqX-IyKfKOJrjfKkr~OfUNEM4nO2k9DEaXAOxkRBDjRO8RqM2lkIAjFgj4nWlKEvyq~itvMSnLo2gPRg__&Key-Pair-Id=KUT5TJCACFTXG","Senator Merv Riepe introduced LB467, legislation that would require state-regulated commercial health plans to implement a prior-authorization application programming interface (API) similar to the federal rule already scheduled for Medicare Advantage and Medicaid managed-care plans.

\"This bill continues our effort to improve the prior authorization process for health care providers, patients, and insurers,\" Riepe said in opening remarks, saying the federal rule requires an API for Medicare Advantage and Medicaid MCOs and LB467 would harmonize Nebraska's commercial market.

Supporters, including the Nebraska Insurance Federation and Blue Cross and Blue Shield of Nebraska, told the committee that standardizing electronic workflows would reduce miscommunication and clerical denials that arise when requests are not handled electronically. Robert Bell, executive director of the Nebraska Insurance Federation, said the legislation mirrors successful statutory language passed in Kansas and urged harmonization with federal implementation timelines.

Insurer witnesses said ERISA-regulated self-funded employer plans are outside state authority and would not be covered by LB467; testimony noted there are roughly 700,000 Nebraskans covered by ERISA plans while about half that number are in state-regulated plans. Blue Cross said the company is beginning implementation for Medicare Advantage and encouraged alignment so providers and plans do not face multiple divergent standards.

Committee members asked about timing and scope. Testimony noted the federal rule has implementation milestones through 2027 and that Kansas gave commercial plans an additional year to comply after the federal deadlines; LB467 similarly included future-dated compliance language.

The committee received proponent testimony and no opponents during the recorded segment; stakeholders urged the committee to advance the bill while aligning state requirements with federal rules to avoid confusion for providers and payers.","LB467 would extend the federal prior-authorization application programming interface (API) requirement — already directed at Medicare Advantage and some federal exchange plans — to fully insured, state-regulated commercial plans. Supporters argued alignment reduces administrative burden; witnesses said ERISA/self-funded plans will remain outside.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6335359,"Nebraska committee hears testimony for LB77 to standardize prior authorization, limit AI-only denials",6029,250000,6279000,"/Search/View?dp=1&key=2289709-f0c4c084bf040d7f91879a7e669920e0&start=250&end=6279","https://assets.pipeline.soar.com/2289709-f0c4c084bf040d7f91879a7e669920e0/thumbnail_250000.jpg","/articles/6335359/Nebraska/Nebraska-committee-hears-testimony-for-LB77-to-standardize-prior-authorization-limit-AI-only-denials","https://secure.pipeline.soar.com/6335359-9d4d8720a2a93818cba7cd7f1af72dbb/orig.mp4?Expires=1776153868&Signature=i35O6IGsVal43dde4bcU4tyQVtPCDdZtQF7xY2GbwTZeuia2c40vlUKOxIOWq0HbSOYbI1PwdkT2HfABW0tgmQJVCe1St8h5kyplkdHZ8HL73YP77kQLuBtnvniurNdBdUiwQ7fGmpT2CJkkNKRBvaAk2FxYIoETUzkQnSC7MoL5KVFFB~4p5zslHi-A-U367x7-IL8Dq~NhDIosGhH4lCVL0vgFl8pu0uE5h4WNfDUDEe3gbbmj65QG6XsB1s~Dwwqt5l7MiixBvpyk~emVHT3Cx97FP3gEGVp5KXKOdlainnIA1vfpaU3gL4ZNkVC21Tpx6kwnZE2dF0wo1YzpYg__&Key-Pair-Id=KUT5TJCACFTXG","The Banking, Commerce and Insurance Committee heard more than two hours of testimony on LB77, the Ensuring Transparency and Prior Authorization Act, a bill introduced by Senator Elliot Bostar proposing statewide standards for health-plan prior authorization procedures.

Supporters called the current prior authorization system a widespread and growing barrier to timely care. \"Prior authorization requirements create substantial challenges for patients and providers,\" Senator Elliot Bostar said when he opened the hearing, summarizing the bill's goals to require accessible criteria, standardized forms and limits on automated denials.

The bill's proponents included hospital leaders, specialty physicians and provider groups who described delays that they said prolong hospital stays and slow start of critical treatments. \"When a child is unable to admit to our facility in a timely manner, it can mean another crisis event affecting the safety of the child or others,\" Amber Mcleod, supervisor of access and utilization review at Boys Town Psychiatric Residential Treatment Facility, told the committee. Ivan Mitchell, CEO of Great Plains Health and testifying for the Nebraska Hospital Association, described a case in which a third-party AI tool denied rehabilitation admission after a prolonged hospitalization and said the patient stayed in the hospital more than 10 weeks while appeals were exhausted.

Oncologists and oncology groups pressed for carve-outs tied to clinical guidelines. \"LB77 would bar insurers from requiring prior authorization specifically in this setting by making cancer care supported by NCCN guidelines exempt from prior authorization,\" Dr. Mary Wells, a medical oncologist, said, arguing delays of days to weeks can change outcomes. She cited research and clinical experience that tied longer time-to-treatment to worse survival for some cancers.

Physicians described administrative burdens and staff time devoted to appeals. \"Physicians and their staff devote an average of 14 hours per week to managing prior authorizations,\" Bostar said in his introduction; physician witnesses and hospital administrators gave similar estimates and offered evidence from AMA surveys and internal analyses showing high overturn rates on appeal.

Insurers and pharmacy benefit managers opposed parts of the bill or urged negotiation, saying it could interfere with ongoing modernization and federal rules. Jeremiah Blakey, government affairs director for Blue Cross and Blue Shield of Nebraska, said his company is already working with providers to reduce unnecessary prior authorizations and urged amendments and further talks. Prime Therapeutics told the committee that prior authorization for drugs is functionally different from services and urged separate treatment for pharmacy coverage.

Committee members asked about scope, timelines, and whether Medicaid managed care organizations were included; proponents said standardization should include Medicaid MCOs, while witnesses noted some federal rules already cover MCOs and Medicare Advantage. Several providers urged prohibiting artificial-intelligence-only denials and requiring adverse determinations be made by appropriately qualified physicians.

The hearing closed with back-and-forth about compromise and next steps. Senator Bostar said he would work with stakeholders and indicated willingness to advance the bill to general file while continuing discussions on technical and implementation issues.

Votes at the hearing: no formal committee votes were recorded on LB77 during the transcripted portion; committee members heard proponent and opponent testimony and asked clarifying questions.

Notes: The article draws only on testimony and statements recorded in the hearing transcript. It does not infer legislative amendments or final outcomes beyond the hearing record.","Supporters including hospitals, physicians and patient advocates told the Banking, Commerce and Insurance Committee that prior authorization delays care and increases costs. LB77 would require clearer criteria, standardized forms, timeline limits, and prohibit AI-only denials; insurers warned of implementation complexity and asked to negotiate.","actionData","errors"]

Article not found

Lawmakers hear debate on LB109 to limit PBM steering, restrict white‑bagging and protect local pharmacies

Nebraska bill would standardize school and childcare anaphylaxis policies, cap EpiPen copays at $60

Bill would require prior-authorization API for Nebraska commercial plans to match federal standards

Nebraska committee hears testimony for LB77 to standardize prior authorization, limit AI-only denials