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Prescription Drug Transparency - Act 165 & 193

 

Act 165 of 2016 (Sec. 2 18 V.S.A. § 4635) tasked the GMCB and DVHA to identify up to 15 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 over the past 12 months. Act 193 of 2018 amended the language (see additional information below). Click here to view the Act 165 Prescription Drug Lists. 

Pursuant to 18 V.S.A. § 4635, the Attorney General, in consultation with DVHA, shall provide a report to the General Assembly on or before December 1st annually based on the information received from manufacturers pursuant to this section. Click here to view the Attorney General's reports on Prescription Drug Cost Transparency.  

Act 193 of 2018, Sec. 9 amended 18 V.S.A. § 4635, entitled “Prescription Drug Cost Transparency.”  The act requires the Department of Vermont Health Access (DVHA) to create annually: 

1) 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. 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. 

2) a list of 10 prescription drugs on which the State spends significant health care dollars and for which the cost to DVHA, 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.

Additionally, each insurer with more than "5,000 covered lives in Vermont for major medical health insurance to create 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 plan, 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 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." 

DVHA and the health insurers shall provide the lists of prescription drugs to the Office of the Attorney General and the Green Mountain Care Board annually on or before June 1 and make the information public on their respective websites. 

Impact of Prescription Drug Costs on Health Insurance Premiums 

Act 193 of 2018, Sec. 8 18 V.S.A. § 4636 entitled "Impact of Prescription Drug Costs on Health Insurance Premiums; Report" requires each "health insurer with more than 1,000 covered lives in this State for major medical health insurance shall report to the Green Mountain Care Board, for all covered prescription drugs, including generic drugs, brand-name drugs, and specialty drugs provided in an outpatient setting or sold in a retail setting:

A) the 25 most frequently prescribed drugs and the average wholesale price for each drug;

B) the 25 most costly drugs by total plan spending and the average wholesale price for each drug; and

C) the 25 drugs with the highest year-over-year price increases and the average wholesale price for each drug". 

The Green Mountain Care Board shall compile the information reported into a consumer-friendly report that demonstrates the overall impact of drug costs on health insurance premiums. The Board shall publish the report on its website on or before January 1 of each year. 

For additional information, please contact Susan Barrett, GMCB Executive Director.