§ 1998. Pharmacy Best Practices and Cost Control Program established
(a) The Commissioner of Vermont Health Access shall establish and maintain a Pharmacy
Best Practices and Cost Control Program designed to reduce the cost of providing prescription
drugs, while maintaining high quality in prescription drug therapies. The Program
shall include:
(1) use of an evidence-based preferred list of covered prescription drugs that identifies
preferred choices within therapeutic classes for particular diseases and conditions,
including generic alternatives and over-the-counter drugs;
(2) utilization review procedures, including a prior authorization review process;
(3) any strategy designed to negotiate with pharmaceutical manufacturers to lower the
cost of prescription drugs for Program participants, including a supplemental rebate
program;
(4) alternative pricing mechanisms, including consideration of using maximum allowable
cost pricing for generic and other prescription drugs;
(5) alternative coverage terms, including consideration of providing coverage of over-the-counter
drugs where cost-effective in comparison to prescription drugs, and authorizing coverage
of dosages capable of permitting the consumer to split each pill if cost-effective
and medically appropriate for the consumer;
(6) a simple, uniform prescription form, designed to implement the preferred drug list,
and to enable prescribers and consumers to request an exception to the preferred drug
list choice with a minimum of cost and time to prescribers, pharmacists, and consumers;
(7) a joint pharmaceuticals purchasing consortium as provided for in subdivision (c)(1)
of this section; and
(8) any other cost containment activity adopted, by rule, by the Commissioner that is
designed to reduce the cost of providing prescription drugs while maintaining high
quality in prescription drug therapies.
(b) The Commissioner shall implement the Pharmacy Best Practices and Cost Control Program
for Medicaid and all other State public assistance program health benefit plans to
the extent permitted by federal law.
(c)(1) The Commissioner may implement the Pharmacy Best Practices and Cost Control Program
for any other health benefit plan within or outside this State that agrees to participate
in the Program. For entities in Vermont, the Commissioner shall directly or by contract
implement the Program through a joint pharmaceuticals purchasing consortium. The joint
pharmaceuticals purchasing consortium shall be offered on a voluntary basis no later
than January 1, 2008, with mandatory participation by State or publicly funded, administered,
or subsidized purchasers to the extent practicable and consistent with the purposes
of this chapter, by January 1, 2010. If necessary, the Department of Vermont Health
Access shall seek authorization from the Centers for Medicare and Medicaid to include
purchases funded by Medicaid. “State or publicly funded purchasers” shall include
the Department of Corrections, the Department of Mental Health, Medicaid, Dr. Dynasaur,
VPharm, Healthy Vermonters, workers’ compensation, and any other State or publicly
funded purchaser of prescription drugs.
(2) The Commissioner of Vermont Health Access and the Secretary of Administration shall
take all steps necessary to enable Vermont’s participation in joint prescription drug
purchasing agreements with any other health benefit plan or organization within or
outside this State that agrees to participate with Vermont in such joint purchasing
agreements.
(3) The Commissioner of Human Resources shall take all steps necessary to enable the State
of Vermont to participate in joint prescription drug purchasing agreements with any
other health benefit plan or organization within or outside this State that agrees
to participate in such joint purchasing agreements, as may be agreed to through the
bargaining process between the State of Vermont and the authorized representatives
of the employees of the State of Vermont.
(4) The actions of the Commissioners and the Secretary shall include:
(A) active collaboration with the National Legislative Association on Prescription Drug
Prices;
(B) active collaboration with the Pharmacy RFP Issuing States initiative organized by
the West Virginia Public Employees Insurance Agency;
(C) the execution of any joint purchasing agreements or other contracts with any participating
health benefit plan or organization within or outside the State that the Commissioner
of Vermont Health Access determines will lower the cost of prescription drugs for
Vermonters while maintaining high quality in prescription drug therapies; and
(D) with regard to participation by the State Employees Health Benefit Plan, the execution
of any joint purchasing agreements or other contracts with any health benefit plan
or organization within or outside the State that the Commissioner of Vermont Health
Access determines will lower the cost of prescription drugs and provide overall quality
of integrated health care services to the State Employees Health Benefit Plan and
the beneficiaries of the Plan, and that is negotiated through the bargaining process
between the State of Vermont and the authorized representatives of the employees of
the State of Vermont.
(5) The Commissioners of Human Resources and of Vermont Health Access may renegotiate
and amend existing contracts to which the Departments of Vermont Health Access and
of Human Resources are parties if such renegotiation and amendment will be of economic
benefit to the health benefit plans subject to such contracts, and to the beneficiaries
of such plans. Any renegotiated or substituted contract shall be designed to improve
the overall quality of integrated health care services provided to beneficiaries of
such plans.
(6) [Repealed.]
(7) The Commissioner of Vermont Health Access, the Commissioner of Human Resources, the
Commissioner of Financial Regulation, and the Secretary of Human Services shall establish
a collaborative process with the Vermont Medical Society, pharmacists, health insurers,
consumers, employer organizations and other health benefit plan sponsors, the National
Legislative Association on Prescription Drug Prices, pharmaceutical manufacturer organizations,
and other interested parties designed to consider and make recommendations to reduce
the cost of prescription drugs for all Vermonters.
(d) A participating health benefit plan other than a State public assistance program may
agree with the Commissioner to limit the plan’s participation to one or more program
components. The Commissioner shall supervise the implementation and operation of the
Pharmacy Best Practices and Cost Control Program, including developing and maintaining
the preferred drug list, to carry out the provisions of the subchapter. The Commissioner
may include such insured or self-insured health benefit plans as agree to use the
preferred drug list or otherwise participate in the provisions of this subchapter.
The purpose of this subchapter is to reduce the cost of providing prescription drugs
while maintaining high quality in prescription drug therapies.
(e) The Commissioner of Vermont Health Access shall develop procedures for the coordination
of State public assistance program health benefit plan benefits with pharmaceutical
manufacturer patient assistance programs offering free or low cost prescription drugs,
including the development of a proposed single application form for such programs.
The Commissioner may contract with a nongovernmental organization to develop the single
application form.
(f)(1) The Drug Utilization Review Board shall make recommendations to the Commissioner for
the adoption of the preferred drug list. The Board’s recommendations shall be based
upon evidence-based considerations of clinical efficacy, adverse side effects, safety,
appropriate clinical trials, and cost-effectiveness. “Evidence-based” shall have the
same meaning as in 18 V.S.A. § 4621. The Commissioner shall provide the Board with evidence-based information about clinical
efficacy, adverse side effects, safety, and appropriate clinical trials and shall
provide information about cost-effectiveness of available drugs in the same therapeutic
class.
(2) The Board shall meet at least quarterly. The Board shall comply with the requirements
of 1 V.S.A. chapter 5, subchapter 2 (Open Meeting Law) and 1 V.S.A. chapter 5, subchapter 3 (Public Records Act), except that the Board may go into executive session
to discuss drug alternatives and receive information on the relative price, net of
any rebates, of a drug under discussion and the drug price in comparison to the prices,
net of any rebates, of alternative drugs available in the same class to determine
cost-effectiveness, and in order to comply with subsection 2002(c) of this title to consider information relating to a pharmaceutical rebate or to supplemental rebate
agreements, which are protected from disclosure by federal law or the terms and conditions
required by the Centers for Medicare and Medicaid Services as a condition of rebate
authorization under the Medicaid program.
(3) To the extent feasible, the Board shall review all drug classes included in the preferred
drug list at least every 24 months and may recommend that the Commissioner make additions
to or deletions from the preferred drug list.
(4) The Program shall establish Board procedures for the timely review of prescription
drugs newly approved by the federal Food and Drug Administration, including procedures
for the review of newly approved prescription drugs in emergency circumstances.
(5) Members of the Board shall receive per diem compensation and reimbursement of expenses
in accordance with 32 V.S.A. § 1010.
(6) The Commissioner shall encourage participation in the joint purchasing consortium
by inviting representatives of the programs and entities specified in subdivision
(c)(1) of this section to participate as observers or nonvoting members in the Drug
Utilization Review Board and by inviting the representatives to use the preferred
drug list in connection with the plans’ prescription drug coverage.
(g) The Department shall seek assistance from entities conducting independent research
into the effectiveness of prescription drugs to provide technical and clinical support
in the development and the administration of the preferred drug list and the evidence-based
education program established in 18 V.S.A. chapter 91, subchapter 2. (Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2003, No. 122 (Adj. Sess.), § 128f; 2003, No. 156 (Adj. Sess.), § 15; 2005, No. 71, § 308; 2005, No. 174 (Adj. Sess.), § 101; 2007, No. 80, §§ 1a, 2; 2009, No. 59, § 9; 2009, No. 1 (Sp. Sess.), § E.309.2; 2009, No. 156 (Adj. Sess.), § I.62; 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2011, No. 171 (Adj. Sess.), § 41c; 2013, No. 79, § 26, eff. Jan. 1, 2014; 2013, No. 131 (Adj. Sess.), § 45, eff. May 20, 2014; 2013, No. 142 (Adj. Sess.), § 98a; 2017, No. 85, § E.306.1.)