Vermont § 3612 - Prohibited practices

§ 3612. Prohibited practices

• (a) A participation contract between a pharmacy benefit manager and a pharmacist shall
  not prohibit, restrict, or penalize a pharmacy or pharmacist in any way from disclosing
  to any covered person any health care information that the pharmacy or pharmacist
  deems appropriate, including: (1) the nature of treatment, risks, or alternatives to treatment; (2) the availability of alternate therapies, consultations, or tests; (3) the decision of utilization reviewers or similar persons to authorize or deny services; (4) the process that is used to authorize or deny health care services; or (5) information on financial incentives and structures used by the health insurer. (b) A pharmacy benefit manager shall not prohibit a pharmacy or pharmacist from: (1) discussing information regarding the total cost for pharmacist services for a prescription
  drug; (2) providing information to a covered person regarding the covered person’s cost-sharing
  amount for a prescription drug; (3) disclosing to a covered person the cash price for a prescription drug; or (4) selling a more affordable alternative to the covered person if a more affordable alternative
  is available. (c) A pharmacy benefit manager contract with a participating pharmacist or pharmacy shall
  not prohibit, restrict, or limit disclosure of information to the Commissioner, law
  enforcement, or State and federal government officials, provided that: (1) the recipient of the information represents that the recipient has the authority,
  to the extent provided by State or federal law, to maintain proprietary information
  as confidential; and (2) prior to disclosure of information designated as confidential, the pharmacist or pharmacy: (A) marks as confidential any document in which the information appears; and (B) requests confidential treatment for any oral communication of the information. (d) A pharmacy benefit manager shall not terminate a contract with or penalize a pharmacist
  or pharmacy due to the pharmacist or pharmacy: (1) disclosing information about pharmacy benefit manager practices, except for information
  determined to be a trade secret under State law or by the Commissioner, when disclosed
  in a manner other than in accordance with subsection (c) of this section; or (2) sharing any portion of the pharmacy benefit manager contract with the Commissioner
  pursuant to a complaint or query regarding the contract’s compliance with the provisions
  of this chapter. (e)(1) A pharmacy benefit manager shall not require a covered person purchasing a covered
  prescription drug to pay an amount greater than the lesser of: (A) the cost-sharing amount under the terms of the health benefit plan, as determined
  in accordance with subdivision (2) of this subsection (e); (B) the maximum allowable cost for the drug; or (C) the amount the covered person would pay for the drug, after application of any known
  discounts, if the covered person were paying the cash price. (2)(A) A pharmacy benefit manager shall attribute any amount paid by or on behalf of a covered
  person under subdivision (1) of this subsection (e), including any third-party payment,
  financial assistance, discount, coupon, or any other reduction in out-of-pocket expenses
  made by or on behalf of a covered person for prescription drugs, toward: (i) the out-of-pocket limits for prescription drug costs under 8 V.S.A. § 4092; (ii) the covered person’s deductible, if any; and (iii) to the extent not inconsistent with Sec. 2707 of the Public Health Service Act, 42 U.S.C. § 300gg-6, the annual out-of-pocket maximums applicable to the covered person’s health benefit
  plan. (B) The provisions of subdivision (A) of this subdivision (2) relating to a third-party
  payment, financial assistance, discount, coupon, or other reduction in out-of-pocket
  expenses made on behalf of a covered person shall only apply to a prescription drug: (i) for which there is no generic drug or interchangeable biological product, as those
  terms are defined in section 4601 of this title; or (ii) for which there is a generic drug or interchangeable biological product, as those
  terms are defined in section 4601 of this title, but for which the covered person has obtained access through prior authorization,
  a step therapy protocol, or the pharmacy benefit manager’s or health benefit plan’s
  exceptions and appeals process. (C) The provisions of subdivision (A) of this subdivision (2) shall apply to a high-deductible
  health plan only to the extent that it would not disqualify the plan from eligibility
  for a health savings account pursuant to 26 U.S.C. § 223. (f) A pharmacy benefit manager shall not conduct or participate in spread pricing in this
  State, which means that a pharmacy benefit manager must ensure that the total amount
  required to be paid by a health benefit plan and a covered person for a prescription
  drug covered under the plan does not exceed the amount paid to the pharmacy for dispensing
  the drug. (Added 2023, No. 127 (Adj. Sess.), § 1, eff. July 1, 2024.)