Vermont 2025-2026 Regular Session

Vermont House Bill H0202 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	BILL AS INTRODUCED H.202
2	2	2025 Page 1 of 7
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5	5	VT LEG #380110 v.1
6	6	H.202 1
7	7	Introduced by Representative Cordes of Bristol 2
8	8	Referred to Committee on 3
9	9	Date: 4
10	10	Subject: Health; health insurance; prescription drugs; pharmacy benefit 5
11	11	managers; pharmacies; hospitals; 340B drug pricing program 6
12	12	Statement of purpose of bill as introduced: This bill proposes to prohibit a 7
13	13	pharmacy benefit manager from requiring a person covered by a health 8
14	14	insurance plan to pay more for a prescription drug than the National Average 9
15	15	Drug Acquisition Cost of the drug plus a professional dispensing fee. The bill 10
16	16	would require pharmacies to post a notice informing covered persons 11
17	17	purchasing prescription drugs that they may ask the pharmacy staff to disclose 12
18	18	certain information regarding their price options. The bill would require 13
19	19	hospitals to report to the Green Mountain Care Board annually about their 14
20	20	participation in the federal 340B drug pricing program. It would also require 15
21	21	health insurers to inform covered persons annually of the actual amount their 16
22	22	health insurance plan spent on prescription drugs on their behalf during the 17
23	23	previous year and would require all entities participating in the 340B program 18
24	24	to inform patients annually if their prescription drugs were purchased through 19
25	25	the 340B program. 20 BILL AS INTRODUCED H.202
26	26	2025 Page 2 of 7
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29	29	VT LEG #380110 v.1
30	30	An act relating to increasing the transparency of prescription drug costs and 1
31	31	spending 2
32	32	It is hereby enacted by the General Assembly of the State of Vermont: 3
33	33	Sec. 1. 18 V.S.A. § 3612 is amended to read: 4
34	34	§ 3612. PROHIBITED PRACTICES 5
35	35	* * * 6
36	36	(e)(1)(A) A pharmacy benefit manager shall not require a covered person 7
37	37	purchasing a covered prescription drug to pay an amount greater than the lesser 8
38	38	of: 9
39	39	(A)(i) the cost-sharing amount under the terms of the health benefit 10
40	40	plan, as determined in accordance with subdivision (2) of this subsection (e); 11
41	41	(B)(ii) the maximum allowable cost for the drug; or 12
42	42	(C)(iii) the amount the covered person would pay for the drug, after 13
43	43	application of any known discounts, if the covered person were paying the cash 14
44	44	price; or 15
45	45	(iv) the current National Average Drug Acquisition Cost plus a 16
46	46	professional dispensing fee in an amount equal to the professional dispensing 17
47	47	fee in effect for the Vermont Medicaid program. 18
48	48	(B) As used in subdivision (A)(iii) of this subdivision (e)(1), “cash 19
49	49	price” means the actual amount the individual would have paid if the 20
50	50	individual had purchased the drug without coverage for the drug under any 21 BILL AS INTRODUCED H.202
51	51	2025 Page 3 of 7
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54	54	VT LEG #380110 v.1
55	55	health benefit plan, which shall include the lowest possible price the individual 1
56	56	would be able to obtain by using a drug discount card. 2
57	57	* * * 3
58	58	Sec. 2. 18 V.S.A. § 3632 is added to read: 4
59	59	§ 3632. DISCLOSURE OF AVAILABILITY OF COST INFORMATION 5
60	60	In order to assure covered persons that they are receiving the best available 6
61	61	price, each pharmacy in this State shall post a notice informing covered 7
62	62	persons purchasing prescription drugs that they may ask the pharmacy staff to 8
63	63	disclose to them the following amounts, as set forth in subdivision 3612(e)(1) 9
64	64	of this chapter: 10
65	65	(1) the cost-sharing amount under the terms of the covered person’s 11
66	66	health benefit plan; 12
67	67	(2) the maximum allowable cost for the drug; 13
68	68	(3) the amount the covered person would pay for the drug, after 14
69	69	application of any known discounts, if the covered person were paying the cash 15
70	70	price; and 16
71	71	(4) the current National Average Drug Acquisition Cost plus a 17
72	72	professional dispensing fee in an amount equal to the professional dispensing 18
73	73	fee in effect for the Vermont Medicaid program. 19 BILL AS INTRODUCED H.202
74	74	2025 Page 4 of 7
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77	77	VT LEG #380110 v.1
78	78	Sec. 3. 18 V.S.A. § 9406 is added to read: 1
79	79	§ 9406. REPORTING ON PARTICIPATION IN 340B DRUG PRICING 2
80	80	PROGRAM 3
81	81	Annually on or before July 1, each hospital participating in the federal 340B 4
82	82	drug pricing program established by 42 U.S.C. § 256b shall submit to the 5
83	83	Green Mountain Care Board a report detailing the hospital’s participation in 6
84	84	the program during the previous calendar year, which report shall be posted on 7
85	85	the Green Mountain Care Board’s website and which shall contain at least the 8
86	86	following information: 9
87	87	(1) the aggregated acquisition cost for all prescription drugs that the 10
88	88	hospital obtained through the 340B program during the previous calendar year; 11
89	89	(2) the aggregated payment amount that the hospital received for all 12
90	90	prescription drugs obtained under the 340B program and dispensed to patients 13
91	91	during the previous calendar year; 14
92	92	(3) the aggregated payment amount that the hospital made to pharmacies 15
93	93	with which the hospital contracted to dispense drugs to its patients under the 16
94	94	340B program during the previous calendar year; 17
95	95	(4) the aggregated payment amount that the hospital made to any other 18
96	96	outside vendor for managing, administering, or facilitating any aspect of the 19
97	97	hospital’s 340B drug program during the previous calendar year; 20 BILL AS INTRODUCED H.202
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101	101	VT LEG #380110 v.1
102	102	(5) all other expenses related to administering the 340B program, 1
103	103	including staffing, operational, and administrative expenses, during the 2
104	104	previous calendar year; 3
105	105	(6) the names of all vendors, including split billing vendors, contract 4
106	106	pharmacies, and pharmacy benefit managers with which the hospital 5
107	107	contracted to provide services associated with the hospital’s 340B program 6
108	108	participation during the previous calendar year; 7
109	109	(7) the number of claims for all prescription drugs the hospital obtained 8
110	110	through the 340B program during the previous calendar year, including the 9
111	111	total number of claims and the number of claims reported separately by payer 10
112	112	type, including Medicare, private insurance, and uninsured; 11
113	113	(8) a description of the ways in which the hospital uses savings from its 12
114	114	participation in the 340B program to benefit its community through programs 13
115	115	and services funded in whole or in part by savings from the 340B program, 14
116	116	including services that support community access to care that the hospital 15
117	117	could not continue without these savings; 16
118	118	(9) a description of the hospital’s internal review and oversight of its 17
119	119	participation in the 340B program in compliance with the U.S. Department of 18
120	120	Health and Human Services, Health Resources and Services Administration’s 19
121	121	340B program rules and guidance; and 20
122	122	(10) such additional information as the Board may request. 21 BILL AS INTRODUCED H.202
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126	126	VT LEG #380110 v.1
127	127	Sec. 4. 18 V.S.A. § 9414b is added to read: 1
128	128	§ 9414b. ANNUAL PRESCRIPTION DRUG DISCLOSURES TO 2
129	129	CONSUMERS 3
130	130	(a) Annually, within 6 months following the end of the plan year, a health 4
131	131	insurer shall provide to each individual covered under a health insurance plan 5
132	132	offered or administered by the health insurer a report of the total amount that 6
133	133	the plan actually spent on prescription drugs for or on behalf of the covered 7
134	134	individual during the previous plan year, net of all rebates and discounts. The 8
135	135	health insurer shall send the prescription drug spending report to the covered 9
136	136	individual at the same address to which the health insurer sends the covered 10
137	137	individual’s explanation of benefits. 11
138	138	(b) Annually, on or before March 1, each covered entity participating in the 12
139	139	federal 340B drug pricing program established by 42 U.S.C. § 256b shall 13
140	140	notify its patients if one or more of the prescription drugs prescribed for the 14
141	141	patient by a health care professional affiliated with the covered entity was 15
142	142	purchased through the 340B program. For a covered entity that is a hospital, 16
143	143	the notice shall include information regarding how to access the report on the 17
144	144	Green Mountain Care Board’s website detailing the hospital’s participation in 18
145	145	the 340B program, including the ways in which the hospital uses savings from 19
146	146	its participation in the 340B program to benefit its community. 20 BILL AS INTRODUCED H.202
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150	150	VT LEG #380110 v.1
151	151	Sec. 5. EFFECTIVE DATE 1
152	152	This act shall take effect on July 1, 2025, with the first report under Sec. 3 2
153	153	(18 V.S.A. § 9406) due on or before July 1, 2026. 3