[{"_1":2,"_100":-5,"_101":-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],{"_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",6297792,"mediaKeyId","2506668-2c127fda7e7edf8fb4bdf8570eabb7cd","parentId",2506668,"title","Bill to set rules for ‘white‑bagging’ specialty drugs prompts insurer and provider debate","audioSeconds",598,"startMs",10821000,"endMs",11419000,"viewUrl","/Search/View?dp=1&key=2506668-2c127fda7e7edf8fb4bdf8570eabb7cd&start=10821&end=11419","thumbnailUrl","https://assets.pipeline.soar.com/2506668-2c127fda7e7edf8fb4bdf8570eabb7cd/thumbnail_10821000.jpg","articleUrl","/articles/6297792/Nebraska/Bill-to-set-rules-for-whitebagging-specialty-drugs-prompts-insurer-and-provider-debate","mediaUrl","https://secure.pipeline.soar.com/6297792-edf7f9ed758e0e9f8d206c1f7568a4b7/orig.mp4?Expires=1771131076&Signature=Fjg5hHSklGcMFVu-9PpaQMZf5J8bUfOYXlgVtV-NG5QmFiwn4VkFsm4qQnea9yDsCSV-CqRdISNEmm2zWmrsA6i9Y5yRUfnyt~L1-7oAE1QX123hkP~MOi9LEvHksbcA5hy-eor4xZfiiSTcUSlVaJsfEnM1jeJq0jtKag6NizKWkybeuQMZNscnXOal37awIqSaNLSyDNwksnEstHHBJy8jxsjBXIeOTVH1DPWfOzSLmfZkGnZ3hA1llleHl5LVjuBhG4hdItp6ytsRLNxcCdylqVUs8tt9CR~h3JQpIDtwJG3u-eimVRVFxSxm0TNP87yv-VdWT0fs4bConnvaJg__&Key-Pair-Id=KUT5TJCACFTXG","author","Nebraska Legislature","date","2025-03-03T00:00:00Z","article","Senator Kathleen Kauth introduced LB533 to set statewide standards for the delivery of clinician‑administered specialty drugs by specialty pharmacies — commonly called \"white‑bagging\" — and to require communication and handling safeguards intended to preserve patient access and lower costs.

Proponents, including the Nebraska Insurance Federation, Blue Cross and Blue Shield of Nebraska and several patient advocates, said the bill would add clarity and predictable procedures so specialty pharmacies, clinicians and payers can coordinate deliveries safely and on time. Robert Bell of the Nebraska Insurance Federation described LB533 as a \"good faith attempt\" to strike a balance between safety and cost containment and pointed to plan examples of large price differentials between hospital‑sourced drug billing and specialty pharmacy acquisition.

Patient families described practical examples in which rapid specialty pharmacy logistics avoided treatment delays, but also noted that miscoordination could produce large surprise charges. Samantha Clinkenbeard, who testified earlier about her son with severe hemophilia, said a hospital dose was provided while a specialty pharmacy overnighted a supply, but \"we were hit with a bill of about $15,000 to $20,000\" and characterized the experience as stressful.

Hospitals and some pharmacists urged caution. Elizabeth Bullshively, a critical‑access hospital pharmacist, told the committee LB533 does not add sufficient operational safeguards for cases where doses are weight‑ or lab‑dependent or where a shipment arrives unusable or not at all. She said small hospitals often lack the cashflow or storage capacity to stock high‑cost drugs for every potential case and that the practical appeal process in LB533 lacked specifics on timing and financial responsibility.

LB533 would require specialty pharmacies to comply with federal shipping rules, to provide 24/7 access for a pharmacist or nurse, to enable five‑day advance notice of delivery details, and to establish a signature on delivery. The bill also requires an appeals or exception process so a treating clinician can obtain medication promptly when there is a delivery failure or an immediate need.

Supporters argued the bill protects patients and plan‑sponsor dollars while addressing safety concerns raised in past hearings. Opponents said the bill needs clearer operational language and stronger enforcement mechanisms before hospitals can agree.

No committee action was taken during the hearing; senators indicated willingness to work with stakeholders to refine technical language.","mediaType","Video","parentTitle","Banking, Commerce and Insurance - 3/3/2025","oneSentenceSummary","LB533 would require process, shipping and communication standards when specialty pharmacies deliver clinician‑administered drugs to clinical sites. Insurers and health plans supported standardized rules; some hospitals and pharmacists expressed safety and operational concerns and asked for stronger guardrails.","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},6297798,"Committee hears LB158 to stop copay accumulators for patients with high‑cost drugs",2867,7516000,10383000,"/Search/View?dp=1&key=2506668-2c127fda7e7edf8fb4bdf8570eabb7cd&start=7516&end=10383","https://assets.pipeline.soar.com/2506668-2c127fda7e7edf8fb4bdf8570eabb7cd/thumbnail_7516000.jpg","/articles/6297798/Nebraska/Committee-hears-LB158-to-stop-copay-accumulators-for-patients-with-highcost-drugs","https://secure.pipeline.soar.com/6297798-b336f3030fd633a30fd940c69ee2b7ba/orig.mp4?Expires=1771131076&Signature=W~bETsUnRL7J5sR54yXv49VbX73uxnJR-4aOcYZIzhbymYKdXbL8Eb4amTU09R1zrCS~TXftx89cYGAEZblmBnFfU0GnZ2u3doe-bCv8cWi6H6v-twc5j~6KDCbaNqemaAiV7iDjTsQ8UuirXCY910pyXxaFM1xbuT245GJzBR2D75L5jJ~ag-H-C91HqZG588KGFBrh0LJO7v0Q2tvbV671rP5r-5u98EtpsNpc2baWaeU93LUh7zgptyLiMCc8StD4KvgyDD-1VJeu6J3HpOBicauL70t6aj40OlNiIx~YjUzdl1b3zqLu8oarhun5MRsZiKuKw4iE-LUi9Pkl3g__&Key-Pair-Id=KUT5TJCACFTXG","Senator Dave Wardekamper presented LB158 at a public hearing of the Banking, Commerce and Insurance Committee, seeking to prohibit health insurers from excluding third‑party copay assistance from a patient’s deductible and out‑of‑pocket accumulation. Supporters said the practice of so‑called \"accumulator adjustment\" programs can leave patients with chronic or rare conditions unable to afford ongoing treatment.

Wardekamper told the committee the policy primarily affects Nebraskans with high‑cost chronic and rare diseases and described common consequences: skipped doses, abandoned treatment and increased emergency care. \"This primarily affects Nebraskans with chronic and rare diseases who already face significant health challenges and high treatment costs,\" he said.

Family members and national patient advocates described personal and financial impacts. Dale Gibbs, a board member of the Nebraska chapter of the National Bleeding Disorders Foundation and father of a person with hemophilia, described medication costs that can ‘‘be as high as $300,000 a year’’ depending on severity and weight, and opposed using manufacturer assistance to count as anything other than patient help.

Multiple family witnesses described near‑term risks when copay assistance runs out and insurers then require full deductibles and out‑of‑pocket payments. Sam Clinkenbeard, father of a 13‑year‑old with severe hemophilia, said a single monthly copay for a specialty medication jumped to $10,000 overnight; he described a short‑term grant that covered the immediate need but warned of recurring exposure when assistance ended.

Supporters argued that counting third‑party assistance toward a patient’s deductible prevents double charging: they said insurers effectively collect the same dollars twice when manufacturers pay copay assistance and the plan later seeks the patient’s deductible as if that assistance had not existed.

Opponents included insurers and industry trade groups. Robert Bell of the Nebraska Insurance Federation warned that LB158 could eliminate plan design tools that help keep premiums lower and that coupon‑style assistance may encourage selection of higher‑priced brand drugs over generics in some cases. Jeremiah Blakey of Blue Cross and Blue Shield of Nebraska said federal programs prohibit manufacturer coupons in Medicare and raised concerns about shifting costs to premiums.

Committee members asked technical questions about alternatives such as direct payments from family members, the interaction of manufacturer assistance with formulary design and the potential federal policy overlap. Wardekamper and witnesses emphasized that many of the drugs affected have no generic equivalents and that adherence saves downstream costs from hospitalizations and disease progression.

No committee action or vote was recorded at the hearing. Several senators indicated an interest in further technical review and in fiscal impact analysis before advancing legislation.

Ending: LB158 frames a common state‑level response to accumulator programs that 21 other states have adopted; the committee hearing surfaced strong personal testimony from affected families as well as insurer warnings about cost and federal constraints.","Sen. Dave Wardekemper introduced LB158 to require insurers to count third‑party copay assistance toward patients' deductibles and out‑of‑pocket limits; families and bleeding‑disorder advocates urged passage, while insurers warned of higher premiums and cited federal constraints.",{"_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},6297803,"Nebraska hearing spotlights PBM reforms as pharmacists warn of rural closures",7124,252000,7376000,"/Search/View?dp=1&key=2506668-2c127fda7e7edf8fb4bdf8570eabb7cd&start=252&end=7376","https://assets.pipeline.soar.com/2506668-2c127fda7e7edf8fb4bdf8570eabb7cd/thumbnail_252000.jpg","/articles/6297803/Nebraska/Nebraska-hearing-spotlights-PBM-reforms-as-pharmacists-warn-of-rural-closures","https://secure.pipeline.soar.com/6297803-0aef2608f84a32e083368f1c45557e79/orig.mp4?Expires=1771131076&Signature=IwLaZtVrK9nMb0iGEFKvvOZL3fEuQigpHbJR~GQCINq6HYV~QsVjhaeRZtjBlDLu5RZAi-6QVbGEbo0gRDoHsWiuG7KHHCYrBBCnxeyJTmxVBKSQ5AT7b2OtAX3QzU5tUhhgEv9O76nYSbv16JG-549O~4G5GNZIaTO4fnW-44BfryAjv8x1ZhE3ODgnX0iGbiIUxFesXl6G0s96sy1J5xzklgldpWMbcJ88hll~ABWPcsFMIBH4-hc5i45uRyiMBWCdKSYO9eJvbe22ETDEsP8wToEEn52CL5jy5QEdpvRCZWAnhz4Pcbbce72gHLwfMjOoICWS1~lRN-L6juAOOQ__&Key-Pair-Id=KUT5TJCACFTXG","At a public hearing of the Nebraska Legislature’s Banking, Commerce and Insurance Committee, Senator Tony Sorrentino introduced LB198, a bill that would add new regulations on pharmacy benefit managers, or PBMs. Sorrentino said the bill targets practices such as spread pricing, patient steering, and below-cost reimbursements.

Supporters — led by independent pharmacists and the Nebraska Pharmacists Association — told the committee that current PBM practices are pushing community pharmacies to close and diminishing local access to medications and basic health services. Opponents, including PBM trade groups and several insurers, said the bill could raise costs, would be difficult to implement, and could expose the state and plans to litigation.

Why this matters: PBMs administer pharmacy benefits for many public and private plans and act as gatekeepers to drug reimbursement and networks. Proponents said lack of transparency and some PBM contracting practices have left community pharmacies financially unsustainable, especially in rural Nebraska; opponents said changes should be coordinated with insurers and other supply‑chain actors to avoid unintended cost shifts.

Senator Tony Sorrentino, the bill’s introducer, framed LB198 around three goals. \"The main intent of LB 198 is to do 3 things, provide transparency and direct pricing, protect community pharmacies, and prohibit spread pricing,\" he told the committee. He described spread pricing as a practice in which a PBM keeps a portion of the difference between what a health plan pays the PBM and what the PBM reimburses the pharmacy.

Pharmacists and pharmacy owners gave examples they said show the effect of current PBM practices on Nebraska communities. David Randolph, president‑elect of the Nebraska Pharmacists Association and owner of Dave’s Pharmacies in Hemingford and Alliance, told the committee: \"We are continuing to see a national crisis unfold in the closing of community pharmacies... According to the Nebraska Board of Pharmacies, since 02/2020, we have seen 69 community pharmacies close, that's around 14%.\"

Owner testimony emphasized rural impact and the role pharmacies play beyond dispensing drugs, such as triage and vaccinations. Geoff Kilborn, owner of Elmwood Pharmacy in Omaha, said he fills many prescriptions reimbursed below acquisition cost and asked the committee for \"guardrails on PBMs.\" Pharmacy chain and hospital representatives (including Hy‑Vee and Nebraska Medicine) supported the bill as a way to preserve access and improve transparency.

PBM and insurer opponents urged caution. Bill Head of PCMA, the PBM trade association, said spread pricing is a contractual choice of plans and employers and that LB198’s requirement that pharmacies never be paid below acquisition cost would be difficult to implement. He asked how a state could determine every pharmacy’s true acquisition cost and warned against guaranteeing a profit on every dispensed item.

Representatives from Prime Therapeutics and Blue Cross and Blue Shield of Nebraska also testified in opposition, arguing the bill could increase costs for consumers by reducing incentives to obtain lower wholesale prices and by shifting costs to premiums. Jeremiah Blakey of Blue Cross said rising drug prices — including a median list price for new drugs cited by national reports — lie at the heart of affordability challenges.

Committee discussion ranged across constitutional questions, ERISA preemption, and precedent. Sorrentino pointed the committee to the U.S. Supreme Court’s Rutledge v. PCMA decision and to Nebraska’s existing PBM law, which he said LB767 (2022) authorized the Department of Insurance to regulate PBMs. He told senators that states can address PBM practices without necessarily running afoul of ERISA, citing Rutledge as persuasive guidance.

No bill vote or committee action occurred at the hearing. The record includes dozens of in‑person proponents and written proponent submissions; witnesses said few or no opponents had submitted written materials.

What’s next: Committee members asked technical and fiscal questions and signaled more hearings and stakeholder negotiation may follow. Supporters urged rapid action to prevent further pharmacy closures; opponents pressed for additional study and for negotiations that include wholesalers and other supply‑chain entities.

Ending: The hearing brought a wide range of practical examples and policy trade‑offs to the committee’s attention — from community pharmacies reporting routine reimbursements under pharmacy acquisition cost to trade groups warning of broader market effects — and left the committee with technical, legal and fiscal issues to resolve before any bill could advance.","Sen. Tony Sorrentino detailed LB198 to regulate pharmacy benefit managers, prompting widespread testimony from Nebraska pharmacists who linked PBM practices to pharmacy closures and access problems; PBM trade groups warned of higher costs and legal complexities.","actionData","errors"]

Article not found

Bill to set rules for ‘white‑bagging’ specialty drugs prompts insurer and provider debate

Committee hears LB158 to stop copay accumulators for patients with high‑cost drugs

Nebraska hearing spotlights PBM reforms as pharmacists warn of rural closures