2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 2001. Legislative oversight

§ 2001. Legislative oversight
(a) Notwithstanding the provisions of 2 V.S.A. § 20(d), the Commissioner of Vermont Health Access shall report annually on or before October 30 to the House Committees on Appropriations, on Health Care, and on Human Services and the Senate Committees on Appropriations and on Health and Welfare concerning the Pharmacy Best Practices and Cost Control Program and the operation of Vermont’s pharmaceutical assistance programs for the most recent State fiscal year. Topics covered in the report shall include:
(1) issues related to drug cost and utilization;
(2) the effect of national trends on the pharmacy programs;
(3) comparisons to other states;
(4) the Department’s administration of Vermont’s pharmaceutical assistance programs;
(5) the Department’s use of prior authorization requirements for prescription drugs; and
(6) decisions made by the Department’s Drug Utilization Review Board in relation to both drug utilization review efforts and the placement of drugs on the Department’s preferred drug list.
(b)(1) The Commissioner shall not enter into a contract with a pharmacy benefit manager unless the pharmacy benefit manager has agreed to disclose to the Commissioner the terms and the financial impact on Vermont and on Vermont beneficiaries of:
(A) any agreement with a pharmaceutical manufacturer to favor the manufacturer’s products over a competitor’s products, or to place the manufacturer’s drug on the pharmacy benefit manager’s preferred list or formulary, or to switch the drug prescribed by the patient’s health care provider with a drug agreed to by the pharmacy benefit manager and the manufacturer;
(B) any agreement with a pharmaceutical manufacturer to share manufacturer rebates and discounts with the pharmacy benefit manager, or to pay “soft money” or other economic benefits to the pharmacy benefit manager;
(C) any agreement or practice to bill Vermont health benefit plans for prescription drugs at a cost higher than the pharmacy benefit manager pays the pharmacy;
(D) any agreement to share revenue with a mail order or Internet pharmacy company;
(E) any agreement to sell prescription drug data concerning Vermont beneficiaries or data concerning the prescribing practices of the health care providers of Vermont beneficiaries; or
(F) any other agreement of the pharmacy benefit manager with a pharmaceutical manufacturer, or with wholesale and retail pharmacies, affecting the cost of pharmacy benefits provided to Vermont beneficiaries.
(2) The Commissioner shall not enter into a contract with a pharmacy benefit manager who has entered into an agreement or engaged in a practice described in subdivision (1) of this subsection, unless the Commissioner determines that the agreement or practice furthers the financial interests of Vermont and does not adversely affect the medical interests of Vermont beneficiaries. (Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 174 (Adj. Sess.), § 103; 2009, No. 33, § 83; 2009, No. 156 (Adj. Sess.), § I.64; 2011, No. 171 (Adj. Sess.), § 41c; 2015, No. 23, § 57; 2015, No. 58, § E.307.1; 2015, No. 97 (Adj. Sess.), § 68; 2015, No. 172 (Adj. Sess.), § E.306.10; 2021, No. 130 (Adj. Sess.), § 2, eff. May 24, 2022.)