Nebraska hearing spotlights PBM reforms as pharmacists warn of rural closures

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.

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