Vermont S 162: An act relating to miscellaneous provisions affecting the Department of Vermont Health Access

Bill Text

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VT LEG #385865 v.1
S.162 1
Introduced by Senator Lyons 2
Referred to Committee on 3
Date: 4
Subject: Health; Department of Vermont Health Access; Medicaid 5
Statement of purpose of bill as introduced: This bill proposes to modify 6
several provisions affecting the Department of Vermont Health Access. It 7
would eliminate the Department’s duty to create annual lists of prescription 8
drugs that have recently experienced significant price increases and provide 9
those lists to the Green Mountain Care Board and the Office of the Attorney 10
General. The bill would modify the membership of the Medicaid and 11
Exchange Advisory Committee and eliminate the Commissioner’s ability to 12
reappoint members to that Committee for additional terms. The bill would 13
update language about reflective health plans to reflect the unmerging of the 14
individual and small group health insurance markets and would modify the 15
composition and term length of members of the Department’s Clinical 16
Utilization Review Board. The bill would also increase the amount of the 17
burial funds exclusion for Medicaid eligibility purposes and would extend the 18
time period within which the Department must seek federal approval for and 19
begin Medicaid coverage of doula services. 20

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VT LEG #385865 v.1
An act relating to miscellaneous provisions affecting the Department of 1
Vermont Health Access 2
It is hereby enacted by the General Assembly of the State of Vermont: 3
Sec. 1. 18 V.S.A. § 4635 is amended to read: 4
§ 4635. PRESCRIPTION DRUG COST TRANSPARENCY 5
(a) As used in this section: 6
(1) “Health insurer” means a health insurer, as defined in section 9402 7
of this title, with more than 5,000 covered lives in this State for major medical 8
health insurance, as defined in 8 V.S.A. § 4011. The term does not include 9
Vermont Medicaid. 10
(2) “Manufacturer” shall have has the same meaning as “pharmaceutical 11
manufacturer” in section 4631a of this title. 12
(2)(3) “Prescription drug” means a drug as defined in 21 U.S.C. § 321. 13
(b)(1)(A) The Department of Vermont Health Access shall create annually 14
a list of 10 prescription drugs on which the State spends significant health care 15
dollars and for which the wholesale acquisition cost has increased by 50 16
percent or more over the past five years or by 15 percent or more during the 17
previous calendar year, creating a substantial public interest in understanding 18
the development of the drugs’ pricing. The list shall include at least one 19
generic and one brand-name drug and shall indicate each of the drugs on the 20
list that the Department considers to be specialty drugs. The Department shall 21
include the percentage of the wholesale acquisition cost increase for each drug 22

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on the list; rank the drugs on the list from those with the largest increase in 1
wholesale acquisition cost to those with the smallest increase; indicate whether 2
each drug was included on the list based on its cost increase over the past five 3
years or during the previous calendar year, or both; and provide the 4
Department’s total expenditure for each drug on the list during the most recent 5
calendar year. 6
(B) The Department of Vermont Health Access shall create annually 7
a list of 10 prescription drugs on which the State spends significant health care 8
dollars and for which the cost to the Department of Vermont Health Access, 9
net of rebates and other price concessions, has increased by 50 percent or more 10
over the past five years or by 15 percent or more during the previous calendar 11
year, creating a substantial public interest in understanding the development of 12
the drugs’ pricing. The list shall include at least one generic and one brand-13
name drug and shall indicate each of the drugs on the list that the Department 14
considers to be specialty drugs. The Department shall rank the drugs on the 15
list from those with the greatest increase in net cost to those with the smallest 16
increase and indicate whether each drug was included on the list based on its 17
cost increase over the past five years or during the previous calendar year, or 18
both. 19
(C)(i) Each health insurer with more than 5,000 covered lives in this 20
State for major medical health insurance shall create annually a list of 10 21

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prescription drugs on which its health insurance plans spend significant 1
amounts of their premium dollars and for which the cost to the plans, net of 2
rebates and other price concessions, has increased by 50 percent or more over 3
the past five years or by 15 percent or more during the previous calendar year, 4
or both, creating a substantial public interest in understanding the development 5
of the drugs’ pricing. The list shall include at least one generic and one br