§ 4605. Alternative drug or biological product selection
(a)(1) When a pharmacist receives a prescription for a drug that is listed either by generic
name or brand name in the most recent edition of or supplement to the U.S. Department
of Health and Human Services’ publication Approved Drug Products With Therapeutic
Equivalence Evaluations (the Orange Book) of approved drug products, the pharmacist
shall select the lowest priced drug from the list that is equivalent as defined by
the Orange Book, unless otherwise instructed by the prescriber, or by the purchaser
if the purchaser agrees to pay any additional cost in excess of the benefits provided
by the purchaser’s health benefit plan if allowed under the legal requirements applicable
to the plan, or otherwise to pay the full cost for the higher-priced drug.
(2) When a pharmacist receives a prescription for a biological product, the pharmacist
shall select the lowest-priced interchangeable biological product unless otherwise
instructed by the prescriber, or by the purchaser if the purchaser agrees to pay any
additional cost in excess of the benefits provided by the purchaser’s health benefit
plan if allowed under the legal requirements applicable to the plan, or otherwise
to pay the full cost for the higher priced biological product.
(3) Notwithstanding subdivisions (1) and (2) of this subsection, when a pharmacist receives
a prescription from a Medicaid beneficiary, the pharmacist shall select the preferred
brand-name or generic drug or biological product from the Department of Vermont Health
Access’s preferred drug list.
(b) The purchaser shall be informed by the pharmacist or his or her representative that
an alternative selection as provided under subsection (a) of this section will be
made unless the purchaser agrees to pay any additional cost in excess of the benefits
provided by the purchaser’s health benefit plan if allowed under the legal requirements
applicable to the plan, or otherwise to pay the full cost for the higher-priced drug
or biological product.
(c) When refilling a prescription, pharmacists shall receive the consent of the prescriber
to dispense a drug or biological product different from that originally dispensed
and shall inform the purchaser that a substitution shall be made pursuant to this
section unless the purchaser agrees to pay any additional cost in excess of the benefits
provided by the purchaser’s health benefit plan if allowed under the legal requirements
applicable to the plan, or otherwise to pay the full cost for the higher-priced drug
or biological product.
(d) Any pharmacist substituting a generically equivalent drug or interchangeable biological
product shall charge no more than the usual and customary retail price for that selected
drug or biological product. This charge shall not exceed the usual and customary retail
price for the prescribed brand.
(e)(1) Except as described in subdivision (4) of this subsection, within five business days
following the dispensing of a biological product, the dispensing pharmacist or designee
shall communicate the specific biological product provided to the patient, including
the biological product’s name and manufacturer, by submitting the information in a
format that is accessible to the prescriber electronically through one of the following:
(A) an interoperable electronic medical records system;
(B) an electronic prescribing technology;
(C) a pharmacy benefit management system; or
(D) a pharmacy record.
(2) Entry into an electronic records system as described in subdivision (1) of this subsection
shall be presumed to provide notice to the prescriber.
(3)(A) If a pharmacy does not have access to one or more of the electronic systems described
in subdivision (1) of this subsection (e), the pharmacist or designee shall communicate
to the prescriber the information regarding the biological product dispensed using
telephone, facsimile, electronic transmission, or other prevailing means.
(B) If a prescription is communicated to the pharmacy by means other than electronic prescribing
technology, the pharmacist or designee shall communicate to the prescriber the information
regarding the biological product dispensed using the electronic process described
in subdivision (1) of this subsection (e) unless the prescriber requests a different
means of communication on the prescription.
(4) Notwithstanding any provision of this subsection to the contrary, a pharmacist shall
not be required to communicate information regarding the biological product dispensed
in the following circumstances:
(A) the U.S. Food and Drug Administration has not approved any interchangeable biological
products for the product prescribed; or
(B) the pharmacist dispensed a refill prescription in which the product dispensed was
unchanged from the product dispensed at the prior filling of the prescription.
(f) The Board of Pharmacy shall maintain a link on its website to the current lists of
all biological products that the U.S. Food and Drug Administration has determined
to be interchangeable biological products. (Added 1977, No. 127 (Adj. Sess.), § 1; amended 2001, No. 63, § 124; 2005, No. 71, § 306, eff. June 21, 2005; 2009, No. 35, § 3; 2017, No. 193 (Adj. Sess.), § 2.)