Nebraska’s term for a collaborative practice agreement (CPA) is a “practice agreement” (PA).

NEB. REV. STAT. ANN. § 38-2867.03 (West 2024).

Short Answer: No, based on the information described below.

No, based on the information described below.

• The definition of the “practice of pharmacy” in Nebraska law does not expressly include prescribing drugs or medications. NEB. REV. STAT. ANN. § 38-2837(1) (West 2024).

• Moreover, under Nebraska pharmacy law, a prescription is issued by a “practitioner,” and the definition of “practitioner” does not include pharmacists. NEB. REV. STAT. ANN. § 38-2838 (West 2024).

• The above points are consistent with DEA information that registered pharmacists in Nebraska cannot obtain the DEA’s mid-level practitioner registration to prescribe controlled substances. (Mid-level Practitioners Authorization by State, DRUG ENFORCEMENT ADMIN. 1 (Nov. 7, 2024))

• Short Answer: No, based on the information described below.
  
  The definition of the “practice of pharmacy” in Nebraska law allows for “the provision of pharmaceutical care.” NEB. REV. STAT. ANN. § 38-2837(1) (West 2024).

• A pharmacist may enter into a practice agreement (PA) with a health care practitioner to provide “pharmaceutical care according to written protocols” to patients. NEB. REV. STAT. ANN. § 38-2867.03(1) (West 2024).

• “Pharmaceutical care” is the process by which a pharmacist works with the patient and other health care professionals “in designing, implementing, and monitoring a therapeutic plan.” NEB. REV. STAT. ANN. § 38-2831 (West 2024). This provision does not expressly refer to prescribing drugs and medications.

• Nebraska laws and regulations contain little additional explanation about what collaborative practice may entail or what can or cannot be included in PAs.

• In addition, Nebraska law governing PAs does not account for the fact that a Nebraska pharmacist cannot obtain a federal DEA mid-level practitioner registration, which precludes the pharmacist from prescribing buprenorphine regardless of what the PA provides.

• In summary, Nebraska law does not expressly prohibit a pharmacist from prescribing controlled substances as part of a PA. However, even if prescribing buprenorphine is theoretically allowed, as a practical matter, there is no way to do it because a Nebraska pharmacist cannot obtain the state/DEA controlled substance registrations necessary.

Short Answer: Yes, based on the information described below.

• The definition of the “practice of pharmacy” in Nebraska expressly includes “the administration of drugs or devices.” NEB. REV. STAT. ANN. § 38-2837(1) (West 2024). This provision does not limit the drugs or medications for which a pharmacist can administer and therefore could mean that a pharmacist can administer buprenorphine generally.

• Unlike the laws and regulations of several other states with general language about administration in the practice of pharmacy definition, there are no other Nebraska laws or regulations that address administration of a small subset of drugs or medications (such as immunizations) that would give the impression that the legislature does not view the “administration of drugs or devices” language as a broad authorization.

Short Answer: As described in the information below, Nebraska laws and regulations do not clearly answer this question. However, given the answer to “Can a pharmacist administer buprenorphine independently?” (see above), the answer is likely “yes.”

• The definition of the “practice of pharmacy” in Nebraska law allows for “the provision of pharmaceutical care.” NEB. REV. STAT. ANN. § 38-2837(1) (West 2024).

• A pharmacist may enter into a PA with a health care practitioner to provide “pharmaceutical care according to written protocols” to patients. NEB. REV. STAT. ANN. § 38- 2867.03(1) (West 2024).

• “Pharmaceutical care” is the process by which a pharmacist works with the patient and other health care professionals “in designing, implementing, and monitoring a therapeutic plan.” NEB. REV. STAT. ANN. § 38-2831 (West 2024). Although this provision uses the phrase implementing and monitoring,” it does not expressly refer to “administration.”

• Nebraska laws and regulations contain little additional explanation about what collaborative practice may entail or what can or cannot be included in PAs.

• Although Nebraska laws and regulations are unclear about administering buprenorphine under PAs, given the response to “Can a pharmacist administer buprenorphine independently?” (see above) that a Nebraska pharmacist has the general authority to administer “drugs and devices,” the most logical answer to this question is “yes.”

Short Answer: No, based on the information described below.

• The definition of the “practice of pharmacy” in Nebraska law does not expressly refer to ordering or evaluating lab tests. NEB. REV. STAT. ANN. § 38-2837(1) (West 2024).

• Moreover, no other Nebraska pharmacy laws or regulations address ordering or evaluating lab tests.

Short Answer: Unclear; As described in the information below, Nebraska laws and regulations do not clearly answer this question.

• The definition of the “practice of pharmacy” in Nebraska law allows for “the provision of pharmaceutical care.” NEB. REV. STAT. ANN. § 38-2837(1) (West 2024).

• A pharmacist may enter into a PA with a health care practitioner to provide “pharmaceutical care according to written protocols” to patients. NEB. REV. STAT. ANN. § 38- 2867.03(1) (West 2024).

• “Pharmaceutical care” is the process by which a pharmacist works with the patient and other health care professionals “in designing, implementing, and monitoring a therapeutic plan.” NEB. REV. STAT. ANN. § 38-2831 (West 2024). This provision does not expressly address whether a pharmacist can order or evaluate the results of lab tests under a PA.

• Moreover, Nebraska laws and regulations contain little additional explanation about what collaborative practice may entail, what can or cannot be included in PAs, and whether that can include ordering or evaluating lab tests.

Short Answer: Yes, based on the information described below.

• Nebraska’s general telehealth/telemedicine practice law provides that any “credential holder under the Uniform Credentialing Act may establish a provider-patient relationship through telehealth.” NEB. REV. STAT. ANN. § 38-1,143(1) (West 2024). This includes pharmacists. NEB. REV. STAT. ANN. § 38-121(1)(hh) (West 2024).

Short Answer: It depends.

Nebraska insurer law provides that “an insurer may contract with a licensed pharmacist for pharmacist professional services.” NEB. REV. STAT. ANN. § 44-313 (West 2024).

Commercial insurance may cover a limited set of pharmacist services - coverage will vary based on each insurance plan’s policies.

References: 

• Jonathan Hughes, State of the Union: A Review of State-based Laws and Regulations Supporting Pharmacist Payment for Clinical Services, Clinical Pharmacy Forum (July 26, 2024) at https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.2008.

• Pharmacist Authority to Initiate PrEP & PEP and Participate in Collaborative Practice Agreements, Nat’l Alliance of State & Territorial AIDS Directors (Aug. 10, 2023) at https://nastad.org/sites/default/files/2023-08/PDF-Pharmacist-Authority-Initiate-PrEP-PEP.pdf

Short Answer: It depends, based on the information described below.

Although not specific to Medicaid, Nebraska insurer law provides that “an insurer may contract with a licensed pharmacist for pharmacist professional services.” NEB. REV. STAT. ANN. § 44-313 (West 2024).

However, as of 2024, tobacco cessation counseling is the only clinical service for which Medicaid may reimburse pharmacists. (see Huges reference below) 471 NEB. ADMIN. CODE § 16.006 (2024).

References: 

• Jonathan Hughes, State of the Union: A Review of State-based Laws and Regulations Supporting Pharmacist Payment for Clinical Services, Clinical Pharmacy Forum (July 26, 2024) at https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.2008.

• Pharmacist Authority to Initiate PrEP & PEP and Participate in Collaborative Practice Agreements, Nat’l Alliance of State & Territorial AIDS Directors (Aug. 10, 2023) at https://nastad.org/sites/default/files/2023-08/PDF-Pharmacist-Authority-Initiate-PrEP-PEP.pdf

Beyond the topics covered above (and excluding methadone) are there any other laws/ regulations governing the way MOUD is provided to patients that currently apply to pharmacists

• No

Are there any such laws/regulations that currently apply to non-pharmacists?

• Buprenorphine is expressly excepted from the Nebraska criminal statute governing the administration of controlled “narcotic drugs” to a “narcotic-dependent person.” NEB. REV. STAT. ANN. § 28-412 (West 2024).