Vermont § 4635 - Prescription drug cost transparency

§ 4635. Prescription drug cost transparency

• (a) As used in this section: (1) “Manufacturer” shall have the same meaning as “pharmaceutical manufacturer” in section 4631a of this title. (2) “Prescription drug” means a drug as defined in 21 U.S.C. § 321. (b)(1)(A) The Department of Vermont Health Access shall create annually a list of 10 prescription
  drugs on which the State spends significant health care dollars and for which the
  wholesale acquisition cost has increased by 50 percent or more over the past five
  years or by 15 percent or more during the previous calendar year, creating a substantial
  public interest in understanding the development of the drugs’ pricing. The list shall
  include at least one generic and one brand-name drug and shall indicate each of the
  drugs on the list that the Department considers to be specialty drugs. The Department
  shall include the percentage of the wholesale acquisition cost increase for each drug
  on the list; rank the drugs on the list from those with the largest increase in wholesale
  acquisition cost to those with the smallest increase; indicate whether each drug was
  included on the list based on its cost increase over the past five years or during
  the previous calendar year, or both; and provide the Department’s total expenditure
  for each drug on the list during the most recent calendar year. (B) The Department of Vermont Health Access shall create annually a list of 10 prescription
  drugs on which the State spends significant health care dollars and for which the
  cost to the Department of Vermont Health Access, net of rebates and other price concessions,
  has increased by 50 percent or more over the past five years or by 15 percent or more
  during the previous calendar year, creating a substantial public interest in understanding
  the development of the drugs’ pricing. The list shall include at least one generic
  and one brand-name drug and shall indicate each of the drugs on the list that the
  Department considers to be specialty drugs. The Department shall rank the drugs on
  the list from those with the greatest increase in net cost to those with the smallest
  increase and indicate whether each drug was included on the list based on its cost
  increase over the past five years or during the previous calendar year, or both. (C)(i) Each health insurer with more than 5,000 covered lives in this State for major medical
  health insurance shall create annually a list of 10 prescription drugs on which its
  health insurance plans spend significant amounts of their premium dollars and for
  which the cost to the plans, net of rebates and other price concessions, has increased
  by 50 percent or more over the past five years or by 15 percent or more during the
  previous calendar year, or both, creating a substantial public interest in understanding
  the development of the drugs’ pricing. The list shall include at least one generic
  and one brand-name drug and shall indicate each of the drugs on the list that the
  health insurer considers to be specialty drugs. The health insurer shall rank the
  drugs on the list from those with the greatest increase in net cost to those with
  the smallest increase and indicate whether each drug was included on the list based
  on its cost increase over the past five years or during the previous calendar year,
  or both. (ii) Each health insurer creating a list pursuant to subdivision (i) of this subdivision
  (b)(1)(C) shall provide to the Office of the Attorney General the percentage by which
  the net cost to its plans increased over the applicable period or periods for each
  drug on the list, as well as the insurer’s total expenditure, net of rebates and other
  price concessions, for each drug on the list during the most recent calendar year.
  Information provided to the Office of the Attorney General pursuant to this subdivision
  (b)(1)(C)(ii) is exempt from public inspection and copying under the Public Records
  Act and shall not be released. (2) The Department of Vermont Health Access and the health insurers shall provide to the
  Office of the Attorney General and the Green Mountain Care Board the lists of prescription
  drugs developed pursuant to subdivisions (1)(A), (B), and (C)(i) of this subsection
  annually on or before June 1. The Office of the Attorney General and the Green Mountain
  Care Board shall make all of the information available to the public on their respective
  websites. (c)(1)(A) Of the prescription drugs listed by the Department of Vermont Health Access and the
  health insurers pursuant to subdivisions (b)(1)(B) and (C) of this section, the Office
  of the Attorney General shall identify 15 drugs as follows: (i) of the drugs appearing on more than one payer’s list, the Office of the Attorney General
  shall identify the top 15 drugs on which the greatest amount of money was spent across
  all payers during the previous calendar year, to the extent information is available;
  and (ii) if fewer than 15 drugs appear on more than one payer’s list, the Office of the Attorney
  General shall rank the remaining drugs based on the amount of money spent by any one
  payer during the previous calendar year, in descending order, and select as many of
  the drugs at the top of the list as necessary to reach a total of 15 drugs. (B) For the 15 drugs identified by the Office of the Attorney General pursuant to subdivision
  (A) of this subdivision (1), the Office of the Attorney General shall require the
  manufacturer of each such drug to provide all of the following: (i) Justification for the increase in the net cost of the drug to the Department of Vermont
  Health Access, to one or more health insurers, or both, which shall be provided to
  the Office of the Attorney General in a format that the Office of the Attorney General
  determines to be understandable and appropriate and shall be provided in accordance
  with a timeline specified by the Office of the Attorney General. The manufacturer
  shall submit to the Office of the Attorney General all relevant information and supporting
  documentation necessary to justify the manufacturer’s net cost increase to the Department
  of Vermont Health Access, to one or more health insurers, or both during the identified
  period of time, including: (I) each factor that specifically caused the net cost increase to the Department of Vermont
  Health Access, to one or more health insurers, or both during the specified period
  of time; (II) the percentage of the total cost increase attributable to each factor; and (III) an explanation of the role of each factor in contributing to the cost increase. (ii) A separate version of the information submitted pursuant to subdivision (i) of this
  subdivision (1)(B), which shall be made available to the public by the Office of the
  Attorney General and the Green Mountain Care Board pursuant to subsection (d) of this
  section. In the event that the manufacturer believes it necessary to redact certain
  information in the public version as proprietary or confidential, the manufacturer
  shall provide an explanation for each such redaction to the Office of the Attorney
  General. The information, format, and any redactions shall be subject to approval
  by the Office of the Attorney General. (iii) Additional information in response to all requests for such information by the Office
  of the Attorney General. (2) Nothing in this section shall be construed to restrict the legal ability of a prescription
  drug manufacturer to change prices to the extent permitted under federal law. (d)(1) The Attorney General shall provide a report to the General Assembly on or before December
  1 of each year based on the information received from manufacturers pursuant to this
  section. The Attorney General shall post the report and the public version of each
  manufacturer’s information submitted pursuant to subdivision (c)(1)(B)(ii) of this
  section on the Office of the Attorney General’s website. (2) The Green Mountain Care Board shall post on its website the report prepared by the
  Attorney General pursuant to subdivision (1) of this subsection and the public version
  of each manufacturer’s information submitted pursuant to subdivision (c)(1)(B)(ii)
  of this section, and may inform the public of the availability of the report and the
  manufacturers’ justification information. (e) Information provided to the Office of the Attorney General pursuant to subdivision
  (c)(1)(B) of this section is exempt from public inspection and copying under the Public
  Records Act and shall not be released in a manner that allows for the identification
  of an individual drug or manufacturer or that is likely to compromise the financial,
  competitive, or proprietary nature of the information, except for the information
  prepared for release to the public pursuant to subdivision (c)(1)(B)(ii) of this section. (f) The Attorney General may bring an action in the Civil Division of the Superior Court,
  Washington County for injunctive relief, costs, and attorney’s fees, and to impose
  on a manufacturer that fails to provide any of the information required by subsection
  (c) of this section, in the format requested by the Office of the Attorney General
  and in accordance with the timeline specified by the Office of the Attorney General,
  a civil penalty of not more than $10,000.00 per violation. Each unlawful failure to
  provide information shall constitute a separate violation. In any action brought pursuant
  to this section, the Attorney General shall have the same authority to investigate
  and to obtain remedies as if the action were brought under the Consumer Protection
  Act, 9 V.S.A. chapter 63. (Added 2015, No. 165 (Adj. Sess.), § 2, eff. June 2, 2016; amended 2017, No. 193 (Adj. Sess.), § 9, eff. May 30, 2018.)