State Codes and Statutes
Statutes > Vermont > Title-33 > Chapter-19 > 2001
§ 2001. Legislative oversight
(a) In connection with the pharmacy best practices and cost control program, the director of the office of Vermont health access shall report for review by the health access oversight committee, prior to initial implementation, and prior to any subsequent modifications:
(1) the compilation that constitutes the preferred drug list or list of drugs subject to prior authorization or any other utilization review procedures;
(2) any utilization review procedures, including any prior authorization procedures; and
(3) the procedures by which drugs will be identified as preferred on the preferred drug list, and the procedures by which drugs will be selected for prior authorization or any other utilization review procedure.
(b) The health access oversight committee shall closely monitor implementation of the preferred drug list and utilization review procedures to ensure that the consumer protection standards enacted pursuant to section 1999 of this title are not diminished as a result of implementing the preferred drug list and the utilization review procedures, including any unnecessary delay in access to appropriate medications. The committee shall ensure that all affected interests, including consumers, health care providers, pharmacists and others with pharmaceutical expertise have an opportunity to comment on the preferred drug list and procedures reviewed under this subsection.
(c) The director of the office of Vermont health access shall report quarterly to the health access oversight committee concerning the following aspects of the pharmacy best practices and cost control program:
(1) the efforts undertaken to educate health care providers about the preferred drug list and the program's utilization review procedures;
(2) the number of prior authorization requests made; and
(3) the number of utilization review events (other than prior authorization requests).
(d) [Repealed.]
(e)(1) [Repealed.]
(2) The director shall not enter into a contract with a pharmacy benefit manager unless the pharmacy benefit manager has agreed to disclose to the director 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.
(3) The director 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 (2) of this subsection, unless the director determines, and certifies in the fiscal report required by subdivision (d)(4) of this section, that such 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.)
