
<p> 1 BILL AS INTRODUCED S.288 2 2004 Page 1 3 4 1 S.288</p><p>2 Introduced by Senator Leddy of Chittenden County, Senator Condos of </p><p>3 Chittenden County, Senator Gossens of Addison County, </p><p>4 Senator Lyons of Chittenden County and Senator Welch of </p><p>5 Windsor County</p><p>6 Referred to Committee on </p><p>7 Date: </p><p>8 Subject: Prescription drugs; programs and practices</p><p>9 Statement of purpose: This bill proposes to (1) require disclosure of retail drug</p><p>10 prices; (2) include over-the-counter drugs on the state’s PDL; (3) amend the </p><p>11 Healthy Vermonters prescription drug program; (4) provide the office of the </p><p>12 attorney general with investigative power under the disclosure laws applicable </p><p>13 to pharmaceutical marketers; (5) require the licensing of PBMs; (6) require the </p><p>14 commissioner of personnel to use the state’s preferred drug list in the state </p><p>15 employees’ health benefit plan; (7) study and report on expanded access to the </p><p>16 340B federal drug pricing program; (8) study and report on savings generated </p><p>17 from purchasing generic rather than brand-name drugs in state drug assistance </p><p>18 programs and in private plans; and (9) require an audit of state contracts with </p><p>19 PBMs as they concern the payment of supplemental rebates.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 2 3 4 1 AN ACT RELATING TO STATE PROGRAMS AND POLICIES ON 2 PRESCRIPTION DRUGS</p><p>3 It is hereby enacted by the General Assembly of the State of Vermont: </p><p>4 * * * Retail Drug Price Disclosure * * *</p><p>5 Sec. 1. 33 V.S.A. § 2007 is added to read:</p><p>6 § 2007. RETAIL DRUG PRICE DISCLOSURE</p><p>7 With each prescription dispensed, the pharmacist shall disclose to the </p><p>8 patient, in writing, the usual and customary price of the prescription and the </p><p>9 cost of any payment toward the price required of the patient.</p><p>10 Sec. 2. EFFECTIVE DATE </p><p>11 Sec. 1 of this act shall take effect July 1, 2004 and apply to a pharmacy on </p><p>12 the date thereafter on which the pharmacy updates its computer software </p><p>13 program with regard to prescription drug price and patient payment, but in no </p><p>14 event later than January 1, 2006.</p><p>15 * * * Over-the-Counter Drug Coverage * * *</p><p>16 Sec. 3. 33 V.S.A. § 1992a is added to read:</p><p>17 § 1992a. OVER-THE-COUNTER DRUG COVERAGE</p><p>18 All public pharmaceutical assistance programs shall provide coverage for </p><p>19 over-the-counter drugs on the preferred drug list developed under section 1998 </p><p>20 of this title.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 3 3 4 1 * * * Healthy Vermonters (Maine Rx Plus) * * *</p><p>2 Sec. 4. 33 V.S.A. § 2003 is amended to read:</p><p>3 § 2003. PHARMACY DISCOUNT PLAN</p><p>4 (a) On or before July 1, 2002, the The commissioner shall implement a </p><p>5 pharmacy discount plan, to be known as the “Healthy Vermonters” program, </p><p>6 for Vermonters without adequate coverage for prescription drugs. The </p><p>7 provisions of section 1992 of this title shall apply to the commissioner’s </p><p>8 authority to administer the pharmacy discount plan established by this section. </p><p>9 The commissioner may establish an enrollment fee in such amount as is </p><p>10 necessary to support the administrative costs of the plan.</p><p>11 (b) The pharmacy discount plan authorized by this section shall include a </p><p>12 program implemented as a Section 1115 Medicaid waiver, wherein the state </p><p>13 makes a payment toward the cost of the drugs dispensed to individuals enrolled</p><p>14 in this program of at least two percent of the cost of each prescription or refill, </p><p>15 consistent with the appropriation for the program established by this section.</p><p>16 (c) The commissioner shall implement the pharmacy discount program </p><p>17 authorized by this section without any financial contribution by the state </p><p>18 otherwise required by subsection (b) of this section, and without federal waiver</p><p>19 approval during such time as federal waiver approval has not been secured.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 4 3 4 1 (d) As used in this section:</p><p>2 (1) “Eligible beneficiary” means any individual Vermont resident </p><p>3 without adequate coverage :</p><p>4 (A) who is at least 65 years of age, or is disabled and is eligible for </p><p>5 Medicare or Social Security disability benefits, with household income equal </p><p>6 to or less than 400 percent of the federal poverty level, as calculated under the </p><p>7 rules of the Vermont health access plan, as amended, and any other individual </p><p>8 Vermont resident with; </p><p>9 (B) whose household income is equal to or less than 300 350 percent </p><p>10 of the federal poverty level, as calculated under the rules of the Vermont health</p><p>11 access plan, as amended; and;</p><p>12 (C) whose family incurs unreimbursed expenses for prescription </p><p>13 drugs that equal five percent or more of family income or whose total </p><p>14 unreimbursed medical expenses equal 15 percent or more of family income.</p><p>15 (2) “Initial discounted cost” means the price of the drug based on the </p><p>16 Medicaid fee schedule.</p><p>17 (3) “Labeler” means an entity or person that receives prescription drugs </p><p>18 from a manufacturer or wholesaler and repackages those drugs for later retail </p><p>19 sale and that has a labeler code from the federal Food and Drug Administration</p><p>20 under 21 Code of Federal Regulations, 207.20 (1999).</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 5 3 4 1 (4) “Participating retail pharmacy” means a retail pharmacy located in </p><p>2 this state or another business licensed to dispense prescription drugs in this </p><p>3 state that participates in the program according to rules established by the </p><p>4 department and provides discounted prices to eligible beneficiaries of the </p><p>5 program.</p><p>6 (5) “Secondary discounted cost” means the price of the drug based on </p><p>7 the Medicaid fee schedule, less payment by the state of at least two percent of </p><p>8 the Medicaid rate, less the average rebate percentage paid to the Medicaid </p><p>9 program by pharmaceutical manufacturers for the prior state fiscal year, as </p><p>10 determined by the commissioner.</p><p>11 (6) “Vermonter without Without adequate coverage” includes eligible </p><p>12 beneficiaries with no coverage for prescription drugs, and eligible beneficiaries</p><p>13 whose annual maximum coverage limit under their health benefit plan has been</p><p>14 reached.</p><p>15 (e) Drugs covered by the Healthy Vermonters program shall include only </p><p>16 drugs that are on the Medicaid preferred drug list as established and revised </p><p>17 from time to time by the department.</p><p>18 (f) Beginning January 1, 2005, a participating retail pharmacy shall offer </p><p>19 beneficiaries the initial discounted price. No later than October 1, 2005, a </p><p>20 participating retail pharmacy shall offer beneficiaries the secondary discounted</p><p>21 price, if available.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 6 3 4 1 (g) The Vermont board of pharmacy shall adopt rules requiring disclosure </p><p>2 by participating retail pharmacies to eligible beneficiaries of the amount of </p><p>3 savings provided as a result of the program. The rules must consider and </p><p>4 protect information that is proprietary in nature. The department may not </p><p>5 impose transaction charges under this program on pharmacies that submit </p><p>6 claims or receive payments under the program. Pharmacies shall submit </p><p>7 claims to the department to verify the amount charged to eligible beneficiaries </p><p>8 under the program. On a weekly or biweekly basis, the department must </p><p>9 reimburse pharmacies for the difference between the initial discounted price </p><p>10 and the secondary discounted price provided to eligible beneficiaries.</p><p>11 (h) The names of drug manufacturers and labelers who do and do not enter </p><p>12 into rebate agreements under this program are public information. The </p><p>13 department shall release this information to health care providers and the </p><p>14 public on a regular basis and shall publicize participation by manufacturers and</p><p>15 labelers. The department shall impose prior authorization requirements in the </p><p>16 Medicaid program, as permitted by law, to the extent the department </p><p>17 determines it is appropriate to do so in order to encourage manufacturer and </p><p>18 labeler participation in the program and so long as the additional prior </p><p>19 authorization requirements remain consistent with the goals of the Medicaid </p><p>20 program and the requirements of Title XIX of the federal Social Security Act.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 7 3 4 1 (i) The commissioner shall establish, by rule, a process to resolve </p><p>2 discrepancies in rebate amounts claimed by manufacturers, labelers, </p><p>3 pharmacies, and the department.</p><p>4 (j) Annually, the department shall report the enrollment and financial status</p><p>5 of the program to the health access oversight committee by September 1, and </p><p>6 to the legislature by January 1.</p><p>7 (k) The department shall undertake outreach efforts to build public </p><p>8 awareness of the program and maximize enrollment. The department may </p><p>9 adjust the requirements and terms of the program to accommodate any new </p><p>10 federally funded prescription drug programs.</p><p>11 (l) The department may contract with a third party or third parties to </p><p>12 administer any or all components of the program, including outreach, </p><p>13 eligibility, claims, administration, and rebate recovery and redistribution.</p><p>14 (m) The department shall administer the program and other medical and </p><p>15 pharmaceutical assistance programs under this title in a manner advantageous </p><p>16 to the programs and enrollees. In implementing this section, the department </p><p>17 may coordinate the other programs and this program and may take actions to </p><p>18 enhance efficiency, reduce the cost of prescription drugs, and maximize </p><p>19 benefits to the programs and enrollees, including providing the benefits of this </p><p>20 program to enrollees in other programs.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 8 3 4 1 (n) The department may adopt rules to implement the provisions of this </p><p>2 section.</p><p>3 (o) The department may seek any waivers of federal law, rule, or regulation</p><p>4 necessary to implement the provisions of this section.</p><p>5 Sec. 5. EFFECTIVE DATE</p><p>6 Sec. 4 of this act shall take effect July 1, 2004, except that subsection </p><p>7 2003(h) of Title 33, requiring public disclosure of manufacturers and labelers </p><p>8 entering into rebate agreements and certain prior authorization requirements </p><p>9 under Medicaid, shall take effect on the date the department begins offering </p><p>10 prescription drug benefits under the program.</p><p>11 * * * Attorney General Investigative Power * * *</p><p>12 Sec. 6. 33 V.S.A. § 2005(b) is amended to read:</p><p>13 (b) The attorney general may bring an action in Washington superior court </p><p>14 for injunctive relief, costs, and attorneys fees, and to impose on a </p><p>15 pharmaceutical manufacturing company that fails to disclose as required by </p><p>16 subsection (a) of this section a civil penalty of no more than $10,000.00 per </p><p>17 violation. Each unlawful failure to disclose shall constitute a separate </p><p>18 violation. The attorney general may issue civil investigative demands and </p><p>19 otherwise investigate alleged violations of subsection (a) of this section </p><p>20 pursuant to 9 V.S.A. § 2460.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 9 3 4 1 * * * PBM Licensing * * *</p><p>2 Sec. 7. 18 V.S.A. chapter 221, subchapter 9 is added to read:</p><p>3 Subchapter 9. Pharmacy Benefit Managers</p><p>4 § 9471. DEFINITIONS</p><p>5 As used in this subchapter:</p><p>6 (1) “Beneficiary” means an individual who has been enrolled in a health</p><p>7 insurance plan in which coverage of prescription drugs is administered by a </p><p>8 pharmacy benefit manager.</p><p>9 (2) “Commissioner” means the commissioner of banking, insurance, </p><p>10 securities, and health care administration.</p><p>11 (3) “Health insurance plan” means a health benefit plan offered, </p><p>12 administered, or issued by a health insurer doing business in Vermont.</p><p>13 (4) “Health insurer” is defined by subdivision 9402(7) of this title. The </p><p>14 term includes:</p><p>15 (A) The state of Vermont and any agent or instrumentality of the </p><p>16 state that offers, administers, or provides financial support to state government </p><p>17 employees.</p><p>18 (B) Medicaid, the Vermont health access plan, the VScript </p><p>19 pharmaceutical assistance program, and any other public health care assistance </p><p>20 program.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 10 3 4 1 (C) To the extent permitted by federal law, any self-insured health </p><p>2 benefit plan that offers health care coverage to Vermont beneficiaries.</p><p>3 (5) “Pharmacy benefit management plan” means an arrangement for the </p><p>4 delivery of prescription services in which a pharmacy benefit manager </p><p>5 undertakes to provide, arrange for, pay for, or reimburse any of the costs of </p><p>6 prescription services for a beneficiary.</p><p>7 (6) “Pharmacy benefits manager” means a business that administers the </p><p>8 prescription drug or device portion of health insurance plans through a </p><p>9 pharmacy benefit management plan on behalf of a health insurance plan.</p><p>10 § 9472. PHARMACY BENEFIT MANAGER; LICENSE REQUIRED</p><p>11 (a) No person shall act as a pharmacy benefit manager or administer a </p><p>12 pharmacy benefit management plan in this state without obtaining an annual </p><p>13 license from the commissioner.</p><p>14 (b) The commissioner may suspend or revoke any license issued to a </p><p>15 pharmacy benefit manager under this subchapter or deny an application for a </p><p>16 license if the commissioner finds that the pharmacy benefit manager or any </p><p>17 officer, employee, or agent of the pharmacy benefit manager has failed to </p><p>18 satisfy any of the following requirements. A pharmacy benefit manager shall:</p><p>19 (1) Fulfill its fiduciary obligations to health insurance plans and health </p><p>20 insurance plan beneficiaries in accordance with the provisions of section 9473 </p><p>21 of this title.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 11 3 4 1 (2) File an annual disclosure statement and secure prior approval of </p><p>2 contracts in accordance with the provisions of section 9474 of this title.</p><p>3 (3) Pay all fees, taxes, and charges required by law.</p><p>4 (4) File a financial statement or statements and any reports, certificates, </p><p>5 or other documents the commissioner considers necessary to secure a full and </p><p>6 accurate knowledge of its affairs and financial condition.</p><p>7 (5) Remain solvent, and its financial condition, method of operation, and</p><p>8 manner of doing business shall remain such as to satisfy the commissioner that </p><p>9 it can meet its obligations to health insurance plans and all beneficiaries.</p><p>10 (6) Comply with all the requirements of law, the provisions of this </p><p>11 subchapter, and the rules adopted pursuant to this subchapter.</p><p>12 (c) A nonrefundable license application fee of $500.00 shall accompany </p><p>13 each application for a license to transact business in this state. The fee shall be</p><p>14 collected by the commissioner and paid directly into the pharmacy benefit </p><p>15 management regulation special fund established and administered under </p><p>16 subchapter 5 of chapter 7 of Title 32 for the purpose of defraying expenses for </p><p>17 the regulation, supervision, and examination of all entities subject to regulation</p><p>18 under this subchapter.</p><p>19 (d) The license required by this section shall be signed by the </p><p>20 commissioner or a duly authorized agent of the commissioner and shall expire </p><p>21 on the next June 30 after the date on which it becomes effective.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 12 3 4 1 (e) All pharmacy benefit managers offering or providing pharmacy benefit </p><p>2 management plans shall obtain an annual renewal of their license from the </p><p>3 commissioner. The commissioner may refuse to renew the license of any </p><p>4 pharmacy benefit manager or may renew the license, subject to any conditions </p><p>5 or restrictions deemed by the commissioner to be needed to carry out the </p><p>6 purposes of this subchapter, if the commissioner finds that the pharmacy </p><p>7 benefit manager has violated any of the requirements for licensure established </p><p>8 in subsection (b) of this section. The commissioner shall not fail to renew the </p><p>9 license of any pharmacy benefit manager without giving the pharmacy benefit </p><p>10 manager notice and an opportunity to be heard in accordance with the </p><p>11 provisions of 3 V.S.A. chapter 25 (Administrative Procedure Act).</p><p>12 (f) The commissioner may adopt such rules as are necessary to carry out </p><p>13 the purposes of this subchapter.</p><p>14 § 9473. FIDUCIARY OBLIGATIONS OF PHARMACY BENEFIT</p><p>15 MANAGERS</p><p>16 A pharmacy benefit manager shall at all times discharge its obligations to </p><p>17 health insurance plans and health insurance plan beneficiaries in compliance </p><p>18 with the standards of conduct applicable to a “fiduciary” under the Employee </p><p>19 Retirement Income Security Act of 1974. In so doing, a pharmacy benefit </p><p>20 manager shall:</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 13 3 4 1 (1) Discharge its duties with respect to health insurance plans and health</p><p>2 insurance plan beneficiaries solely in the interest of such plans and </p><p>3 beneficiaries, and for the exclusive purpose of providing benefits to such plans </p><p>4 and beneficiaries and defraying reasonable expenses of administering health </p><p>5 insurance plan and health insurance plan beneficiary benefits. </p><p>6 (2) Discharge its duties with the care, skill, prudence, and diligence </p><p>7 under the circumstances then prevailing that a prudent fiduciary acting in like </p><p>8 capacity and familiar with such matters would use in the conduct of an </p><p>9 enterprise of a like character and with like aims.</p><p>10 (3) Discharge its duties in accordance with the contract governing the </p><p>11 health insurance plan prescription drug coverage, insofar as such contract is </p><p>12 consistent with the provisions of this law and of the Employee Retirement </p><p>13 Income Security Act of 1974.</p><p>14 (4) Provide any and all information requested by health insurance plans </p><p>15 so as to ensure that such plans are able to ascertain all material activities being </p><p>16 undertaken on their behalf or on behalf of health insurance plan beneficiaries.</p><p>17 (5) Notify health insurance plans in writing of any proposed or ongoing </p><p>18 activity that involves, directly or indirectly, any conflict of interest as </p><p>19 contemplated by the standards applicable to a “fiduciary” under the Employee </p><p>20 Retirement Income Security Act of 1974.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 14 3 4 1 § 9474. ANNUAL STATEME NT; PRIOR APPROVAL OF CONTRACTS</p><p>2 (a) Each pharmacy benefit manager providing pharmacy benefit </p><p>3 management plans in this state shall file a statement with each health insurance</p><p>4 plan and with the commissioner annually by March 1. The statement shall be </p><p>5 verified by at least two principal officers and shall cover the preceding </p><p>6 calendar year. The annual statement shall be on forms prescribed by the </p><p>7 commissioner, and shall include:</p><p>8 (1) A financial statement of the organization, including its balance sheet </p><p>9 and income statement for the preceding year.</p><p>10 (2) The number of persons enrolled during the year, the number of </p><p>11 enrollees as of the end of the year, and the number of enrollments terminated </p><p>12 during the year.</p><p>13 (3) Any other information relating to the operations of the pharmacy </p><p>14 benefit manager required by the commissioner pursuant to this subchapter.</p><p>15 (b) A pharmacy benefit manager shall not enter into a contract with a health</p><p>16 insurance plan unless the commissioner first determines, upon application by </p><p>17 the pharmacy benefit manager on a form and in a manner approved by the </p><p>18 commissioner, that the pharmacy benefit manager has disclosed to the health </p><p>19 insurance plan any of the following agreements and practices, and that the </p><p>20 commissioner has determined that the contract and any such agreement and </p><p>21 practice promotes the medical and financial interests of the health insurance </p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 15 3 4 1 plan and the beneficiaries of the health insurance plan. The pharmacy benefit </p><p>2 manager shall disclose:</p><p>3 (1) Any agreement with a pharmaceutical manufacturer to favor the </p><p>4 manufacturer’s products over a competitor’s products, or to place the </p><p>5 manufacturer’s drug on the pharmacy benefit manager’s preferred list or </p><p>6 formulary, or to switch the drug prescribed by the patient’s health care </p><p>7 provider with a drug agreed to by the pharmacy benefit manager and the </p><p>8 manufacturer.</p><p>9 (2) Any agreement with a pharmaceutical manufacturer to share </p><p>10 manufacturer rebates and discounts with the pharmacy benefit manager, or to </p><p>11 pay “soft money” or other economic benefits to the pharmacy benefit manager.</p><p>12 (3) Any agreement or practice to bill Vermont health benefit plans for </p><p>13 prescription drugs at a cost higher than the pharmacy benefit manager pays the </p><p>14 pharmacy.</p><p>15 (4) Any agreement to share revenue with a mail order or internet </p><p>16 pharmacy company.</p><p>17 (5) Any agreement to sell prescription drug data concerning Vermont </p><p>18 beneficiaries, or data concerning the prescribing practices of the health care </p><p>19 providers of Vermont beneficiaries.</p><p>20 (6) Any corporate or other organizational or governing affiliation </p><p>21 between the pharmacy benefit manager and a pharmaceutical manufacturer.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 16 3 4 1 (7) Any other agreement of the pharmacy benefit manager with a </p><p>2 pharmaceutical manufacturer, or with wholesale and retail pharmacies, </p><p>3 affecting the cost of pharmacy benefits provided to Vermont beneficiaries. </p><p>4 (c) A contract filed under this section shall be deemed approved unless the </p><p>5 commissioner disapproves such contract within 30 days after filing with the </p><p>6 commissioner. Disapproval shall be in writing, stating the reasons therefor and</p><p>7 a copy thereof delivered to the pharmacy benefit manager.</p><p>8 § 9475. ASSESSMENT</p><p>9 (a) The expenses of administering this subchapter, including the cost </p><p>10 incurred by the commissioner, shall be assessed annually by the commissioner </p><p>11 against all pharmacy benefit managers operating in this state. Before </p><p>12 determining the assessment, the commissioner shall provide an estimate of all </p><p>13 expenses for the regulation, supervision, and examination of all entities subject</p><p>14 to regulation under this chapter. The assessment shall be in proportion to the </p><p>15 business done in this state.</p><p>16 (b) All fees and assessments under this subchapter and paid to the </p><p>17 commissioner shall be deposited in the pharmacy benefit management </p><p>18 regulation special fund established and administered under subchapter 5 of </p><p>19 chapter 7 of Title 32 for the purpose of defraying the expenses for the </p><p>20 regulation, supervision, and examination of all entities subject to regulation </p><p>21 under this subchapter.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 17 3 4 1 (c) The commissioner shall give each pharmacy benefit manager notice of </p><p>2 the assessment, which shall be paid to the department annually on or before </p><p>3 March 1. Any pharmacy benefit manager that fails to pay the assessment on or</p><p>4 before the date prescribed in this subsection shall be subject to a penalty </p><p>5 imposed by the commissioner. The penalty shall be ten percent of the </p><p>6 assessment and interest for the period between the due date and the date of full </p><p>7 payment. If a payment is made in an amount later found to be in error, the </p><p>8 commissioner shall:</p><p>9 (1) If an additional amount is due, notify the company of the additional </p><p>10 amount and the company shall pay the additional amount within 14 days of the</p><p>11 date of the notice.</p><p>12 (2) If an overpayment is made, order a refund.</p><p>13 (d) If an assessment made under this subchapter is not paid to the </p><p>14 commissioner by the prescribed date, the amount of the assessment, penalty, </p><p>15 and interest may be recovered from the defaulting company on motion of the </p><p>16 commissioner made in the name and for the use of the state in the appropriate </p><p>17 superior court after ten days’ notice to the company. The license of any </p><p>18 defaulting pharmacy benefit manager to transact business in this state may be </p><p>19 revoked or suspended by the commissioner until the manager has paid such </p><p>20 assessment.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 18 3 4 1 § 9476. ENFORCEMENT</p><p>2 In addition to any other remedy provided by law, a health insurance plan or </p><p>3 a plan beneficiary aggrieved by a violation of this subchapter or a rule adopted </p><p>4 under this subchapter may file an action in superior court for injunctive relief </p><p>5 and an award of compensatory and punitive damages. The superior court may </p><p>6 award to the health insurance plan or plan beneficiary who prevails in an action</p><p>7 under this section reasonable costs and attorney’s fees.</p><p>8 * * * Joint Purchasing within Vermont * * *</p><p>9 Sec. 8. 33 V.S.A. § 1998 is amended to read:</p><p>10 § 1998. PHARMACY BEST PRACTICES AND COST CONTROL </p><p>11 PROGRAM ESTABLISHED</p><p>12 (a) The commissioner of prevention, assistance, transition, and health </p><p>13 access shall establish a pharmacy best practices and cost control program </p><p>14 designed to reduce the cost of providing prescription drugs, while maintaining </p><p>15 high quality in prescription drug therapies. The program shall include:</p><p>16 (1) A preferred list of covered prescription drugs that identifies </p><p>17 preferred choices within therapeutic classes for particular diseases and </p><p>18 conditions, including generic alternatives and over-the-counter drugs.</p><p>19 (A) The commissioner, and the commissioner of banking, insurance, </p><p>20 securities, and health care administration shall implement the preferred drug </p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 19 3 4 1 list as a uniform, statewide preferred drug list by encouraging all health benefit</p><p>2 plans in this state to participate in the program.</p><p>3 (B) The commissioner of personnel shall use the preferred drug list in</p><p>4 the state employees health benefit plan only if participation in the program will</p><p>5 provide economic and health benefits to the state employees health benefit plan</p><p>6 and to beneficiaries of the plan, and only if agreed to through the bargaining </p><p>7 process between the state of Vermont and the authorized representatives of the </p><p>8 employees of the state of Vermont. The provisions of this subdivision do not </p><p>9 authorize the actuarial pooling of the state employees health benefit plan with </p><p>10 any other health benefit plan, unless otherwise agreed to through the </p><p>11 bargaining process between the state of Vermont and the authorized </p><p>12 representatives of the employees of the state of Vermont.</p><p>13 * * *</p><p>14 * * * Expanding Use of 340B Programs * * *</p><p>15 Sec. 9. 33 V.S.A. § 2008 is added to read:</p><p>16 § 2008. FEDERAL DISCOUNT PROGRAMS; STUDY</p><p>17 The commissioner shall study and by January 1, 2005 report to the </p><p>18 governor, the senate and house committees on health and welfare, and the </p><p>19 health access oversight committee on the feasibility of providing discounted </p><p>20 prescription drugs to Vermont’s most vulnerable patient populations through </p><p>21 the use of Section 340B of the federal Public Health Service Act, 42 United </p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 20 3 4 1 States Code, Section 256b (1999). The commissioner shall work with other </p><p>2 state agencies, representatives of state employees, and representatives of health</p><p>3 care providers and facilities in the state to provide the following information:</p><p>4 (1) A description of all health care providers and facilities in the state </p><p>5 potentially eligible for designation as “covered entities” under Section 340B, </p><p>6 including without limitation all hospitals eligible as disproportionate share </p><p>7 hospitals; recipients of grants from the United States Public Health Service; </p><p>8 federally qualified health centers; federally qualified look-alikes; </p><p>9 state - operated AIDS drug assistance programs; Ryan White CARE Act Title I, </p><p>10 Title II, and Title III programs; tuberculosis, black lung, family planning, and </p><p>11 sexually transmitted disease clinics; hemophilia treatment centers; public </p><p>12 housing primary care clinics; and clinics for homeless people.</p><p>13 (2) A listing of potential applications of Section 340B and the potential </p><p>14 benefits to public, private, and third-party payors for prescription drugs, </p><p>15 including:</p><p>16 (A) application to inmates and employees in youth correctional </p><p>17 facilities, county jails, and state prisons;</p><p>18 (B) maximizing the use of Section 340B within state-funded </p><p>19 managed care plans;</p><p>20 (C) including Section 340B providers in state bulk purchasing </p><p>21 initiatives; and</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 21 3 4 1 (D) using sole source contracts with Section 340B providers to </p><p>2 furnish high-cost chronic care drugs.</p><p>3 (3) Discounts available through Section 340B contracts, including </p><p>4 estimated cost savings to the state as a result of retail mark-up avoidance, </p><p>5 negotiated subceiling prices, and coordination with the Medicaid program in </p><p>6 order to minimize costs to the program and to other purchasers of prescription </p><p>7 drugs.</p><p>8 (4) The resources available to potential applicants for designation as </p><p>9 covered entities for the application process, establishing a Section 340B </p><p>10 program, restructuring the health care system, or other methods of lowering the</p><p>11 cost of prescription drugs. The resources must include state and federal </p><p>12 agencies and private philanthropic grants to be used for the purposes of this </p><p>13 section.</p><p>14 * * * Study on Savings * * *</p><p>15 Sec. 10. REPORT ON PRESCRIPTION DRUG SAVINGS</p><p>16 The commissioner of prevention, assistance, transition, and health access </p><p>17 shall conduct a study to demonstrate any savings achieved through the use of </p><p>18 generic instead of brand-name drugs in state and, to the extent possible, private</p><p>19 drug assistance plans. The findings of the study shall be reported to the health </p><p>20 access oversight committee and the senate and house committees on health and</p><p>21 welfare by January 1, 2005.</p><p>5 www.leg.state.vt.us 1 BILL AS INTRODUCED S.288 2 2004 Page 22 3 4 1 * * * Auditing PBM Contracts * * *</p><p>2 Sec. 11. AUDITING PBM CONTRACTS</p><p>3 The commissioner of prevention, assistance, transition, and health access </p><p>4 and the commissioner of personnel, in consultation with the commissioner of </p><p>5 banking, insurance, securities, and health care administration and the state </p><p>6 auditor, shall develop a pharmacy benefits manager audit plan. The purpose of</p><p>7 the audit plan is to ensure that pharmacy claims and rebates are being paid </p><p>8 accurately and appropriately. Accordingly, the audit shall include a </p><p>9 performance audit, contract compliance audit, rebate audit, and pharmacy </p><p>10 claims analysis and audit. The audit plan shall include a cost estimate for </p><p>11 hiring an independent auditor, options for keeping the cost of the audit down, </p><p>12 for example, by partnering with other health benefit plans within or outside the</p><p>13 state, as well as recommendations regarding possible revenue sources to cover </p><p>14 the cost of implementing the audit plan. The audit plan shall be detailed in a </p><p>15 report submitted to the health access oversight committee and the senate and </p><p>16 house committees on health and welfare by September 1, 2004.</p><p>5 www.leg.state.vt.us</p>
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