State Codes and Statutes

Statutes > Vermont > Title-33 > Chapter-19 > 2074

§ 2074. VermontRx program

(a) Effective January 1, 2006, VermontRx is established within the office of Vermont health access and shall be the continuation of the state pharmaceutical programs in existence upon passage of this subchapter for those individuals not eligible for Medicare part D. VermontRx is a pharmaceutical assistance program for individuals age 65 or older who are not eligible for Medicare and for individuals with disabilities who are receiving Social Security disability benefits and who are not eligible for Medicare. VermontRx may retain the current program names of VHAP-Pharmacy, VScript, and VScript Expanded if it is cost-effective to retain the current names in lieu of combining the current programs into one program.

(1) The program shall be administered by OVHA which, to the extent funding permits, shall establish application, eligibility, coverage, and payment standards. In addition to the general eligibility requirements established in section 2072 of this title, an individual must not be eligible for Medicare in order to be eligible for benefits under VermontRx.

(2) To the extent necessary under federal law, OVHA shall administer VermontRx in such a manner as to ensure that any permissible federal funding may be received to support the program. OVHA may establish a division of the VermontRx program to administer federal Medicaid funds separately in accordance with a federal waiver pursuant to Section 1115 of the Social Security Act.

(3) If permissible under federal law, OVHA shall use the same forms and application process for individuals to enroll in VermontRx, regardless of the funding source for the program.

(b) VermontRx shall provide:

(1) the same pharmaceutical coverage as the Medicaid program to elderly individuals and individuals with disabilities whose income is no greater than 150 percent of the federal poverty guidelines; and

(2) maintenance drugs to elderly individuals and individuals with disabilities whose income is greater than 150 percent and no greater than 225 percent of the federal poverty guidelines.

(c) Benefits under VermontRx shall be subject to payment of a premium and co-payment amounts by the recipient in accordance with the provisions of this section.

(1) In the case of recipients whose household income is no greater than 150 percent of the federal poverty level, the premium shall be $17.00 per month.

(2) In the case of recipients whose household income is greater than 150 percent of the federal poverty level and no greater than 175 percent of the federal poverty level, the premium shall be $23.00 per month.

(3) In the case of recipients whose household income is greater than 175 percent of the federal poverty level and no greater than 225 percent of the federal poverty level, the premium shall be $50.00 per month.

(4) A recipient shall contribute a co-payment of $1.00 for prescriptions costing $29.99 or less and a co-payment of $2.00 for prescriptions costing $30.00 or more. A pharmacy may not refuse to dispense a prescription to an individual who does not provide the co-payment.

(d) Any manufacturer of pharmaceuticals purchased by individuals receiving assistance from VermontRx established under this section shall pay to OVHA, as a condition of participation in the program, a rebate in an amount at least as favorable as the rebate paid to OVHA in connection with the Medicaid program.

(e) Under VermontRx, a pharmaceutical may be dispensed to an eligible recipient provided such dispensing is pursuant to and in accordance with any contractual arrangement that OVHA may enter into or approve for the group discount purchase of pharmaceuticals. When a person or business located in Vermont and employing citizens of this state has submitted a bid for the group discount purchase of pharmaceuticals and has not been selected, the director of OVHA shall record the reason for nonselection. The director's report shall be a public record available to any interested person. All bids or quotations shall be kept on file in the director's office and open to public inspection. (Added 2005, No. 71, § 314; amended 2007, No. 192 (Adj. Sess.), § 6.018; 2009, No. 1 (Sp. Sess.), § E.309.8.)

State Codes and Statutes

Statutes > Vermont > Title-33 > Chapter-19 > 2074

§ 2074. VermontRx program

(a) Effective January 1, 2006, VermontRx is established within the office of Vermont health access and shall be the continuation of the state pharmaceutical programs in existence upon passage of this subchapter for those individuals not eligible for Medicare part D. VermontRx is a pharmaceutical assistance program for individuals age 65 or older who are not eligible for Medicare and for individuals with disabilities who are receiving Social Security disability benefits and who are not eligible for Medicare. VermontRx may retain the current program names of VHAP-Pharmacy, VScript, and VScript Expanded if it is cost-effective to retain the current names in lieu of combining the current programs into one program.

(1) The program shall be administered by OVHA which, to the extent funding permits, shall establish application, eligibility, coverage, and payment standards. In addition to the general eligibility requirements established in section 2072 of this title, an individual must not be eligible for Medicare in order to be eligible for benefits under VermontRx.

(2) To the extent necessary under federal law, OVHA shall administer VermontRx in such a manner as to ensure that any permissible federal funding may be received to support the program. OVHA may establish a division of the VermontRx program to administer federal Medicaid funds separately in accordance with a federal waiver pursuant to Section 1115 of the Social Security Act.

(3) If permissible under federal law, OVHA shall use the same forms and application process for individuals to enroll in VermontRx, regardless of the funding source for the program.

(b) VermontRx shall provide:

(1) the same pharmaceutical coverage as the Medicaid program to elderly individuals and individuals with disabilities whose income is no greater than 150 percent of the federal poverty guidelines; and

(2) maintenance drugs to elderly individuals and individuals with disabilities whose income is greater than 150 percent and no greater than 225 percent of the federal poverty guidelines.

(c) Benefits under VermontRx shall be subject to payment of a premium and co-payment amounts by the recipient in accordance with the provisions of this section.

(1) In the case of recipients whose household income is no greater than 150 percent of the federal poverty level, the premium shall be $17.00 per month.

(2) In the case of recipients whose household income is greater than 150 percent of the federal poverty level and no greater than 175 percent of the federal poverty level, the premium shall be $23.00 per month.

(3) In the case of recipients whose household income is greater than 175 percent of the federal poverty level and no greater than 225 percent of the federal poverty level, the premium shall be $50.00 per month.

(4) A recipient shall contribute a co-payment of $1.00 for prescriptions costing $29.99 or less and a co-payment of $2.00 for prescriptions costing $30.00 or more. A pharmacy may not refuse to dispense a prescription to an individual who does not provide the co-payment.

(d) Any manufacturer of pharmaceuticals purchased by individuals receiving assistance from VermontRx established under this section shall pay to OVHA, as a condition of participation in the program, a rebate in an amount at least as favorable as the rebate paid to OVHA in connection with the Medicaid program.

(e) Under VermontRx, a pharmaceutical may be dispensed to an eligible recipient provided such dispensing is pursuant to and in accordance with any contractual arrangement that OVHA may enter into or approve for the group discount purchase of pharmaceuticals. When a person or business located in Vermont and employing citizens of this state has submitted a bid for the group discount purchase of pharmaceuticals and has not been selected, the director of OVHA shall record the reason for nonselection. The director's report shall be a public record available to any interested person. All bids or quotations shall be kept on file in the director's office and open to public inspection. (Added 2005, No. 71, § 314; amended 2007, No. 192 (Adj. Sess.), § 6.018; 2009, No. 1 (Sp. Sess.), § E.309.8.)


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State Codes and Statutes

Statutes > Vermont > Title-33 > Chapter-19 > 2074

§ 2074. VermontRx program

(a) Effective January 1, 2006, VermontRx is established within the office of Vermont health access and shall be the continuation of the state pharmaceutical programs in existence upon passage of this subchapter for those individuals not eligible for Medicare part D. VermontRx is a pharmaceutical assistance program for individuals age 65 or older who are not eligible for Medicare and for individuals with disabilities who are receiving Social Security disability benefits and who are not eligible for Medicare. VermontRx may retain the current program names of VHAP-Pharmacy, VScript, and VScript Expanded if it is cost-effective to retain the current names in lieu of combining the current programs into one program.

(1) The program shall be administered by OVHA which, to the extent funding permits, shall establish application, eligibility, coverage, and payment standards. In addition to the general eligibility requirements established in section 2072 of this title, an individual must not be eligible for Medicare in order to be eligible for benefits under VermontRx.

(2) To the extent necessary under federal law, OVHA shall administer VermontRx in such a manner as to ensure that any permissible federal funding may be received to support the program. OVHA may establish a division of the VermontRx program to administer federal Medicaid funds separately in accordance with a federal waiver pursuant to Section 1115 of the Social Security Act.

(3) If permissible under federal law, OVHA shall use the same forms and application process for individuals to enroll in VermontRx, regardless of the funding source for the program.

(b) VermontRx shall provide:

(1) the same pharmaceutical coverage as the Medicaid program to elderly individuals and individuals with disabilities whose income is no greater than 150 percent of the federal poverty guidelines; and

(2) maintenance drugs to elderly individuals and individuals with disabilities whose income is greater than 150 percent and no greater than 225 percent of the federal poverty guidelines.

(c) Benefits under VermontRx shall be subject to payment of a premium and co-payment amounts by the recipient in accordance with the provisions of this section.

(1) In the case of recipients whose household income is no greater than 150 percent of the federal poverty level, the premium shall be $17.00 per month.

(2) In the case of recipients whose household income is greater than 150 percent of the federal poverty level and no greater than 175 percent of the federal poverty level, the premium shall be $23.00 per month.

(3) In the case of recipients whose household income is greater than 175 percent of the federal poverty level and no greater than 225 percent of the federal poverty level, the premium shall be $50.00 per month.

(4) A recipient shall contribute a co-payment of $1.00 for prescriptions costing $29.99 or less and a co-payment of $2.00 for prescriptions costing $30.00 or more. A pharmacy may not refuse to dispense a prescription to an individual who does not provide the co-payment.

(d) Any manufacturer of pharmaceuticals purchased by individuals receiving assistance from VermontRx established under this section shall pay to OVHA, as a condition of participation in the program, a rebate in an amount at least as favorable as the rebate paid to OVHA in connection with the Medicaid program.

(e) Under VermontRx, a pharmaceutical may be dispensed to an eligible recipient provided such dispensing is pursuant to and in accordance with any contractual arrangement that OVHA may enter into or approve for the group discount purchase of pharmaceuticals. When a person or business located in Vermont and employing citizens of this state has submitted a bid for the group discount purchase of pharmaceuticals and has not been selected, the director of OVHA shall record the reason for nonselection. The director's report shall be a public record available to any interested person. All bids or quotations shall be kept on file in the director's office and open to public inspection. (Added 2005, No. 71, § 314; amended 2007, No. 192 (Adj. Sess.), § 6.018; 2009, No. 1 (Sp. Sess.), § E.309.8.)


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