Drug List Per Act 165

Act 165 of 2016 requires that the Green Mountain Care Board (GMCB), in collaboration with the Department of Vermont Health Access (DVHA):

 [i]dentify annually 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, creating a substantial public interest in understanding the development of the drugs’ pricing.

Act 193 of 2018 amended certain statutory provisions, including 18 V.S.A. § 4635, entitled    “Prescription Drug Cost Transparency.”  The act expands the provisions of Vermont’s existing prescription drug transparency to require the Department of Vermont Health Access (“DHVA”) and health insurers with more than 5,000 covered lives in Vermont to create lists of 10 prescription drugs for which the payer’s net cost has increased by 50 percent or more over the past five years or 15 percent or more over the past calendar year.  The pre-existing law related only to drugs purchased by the State for which the wholesale acquisition cost increased by 50 percent or more over the prior 5 years or by 15% or more over the prior 12 months.

18 V.S.A. § 4635 requires that DHVA annually create:

  • A list of 10 prescription drugs (at least one generic and one brand name) 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; and
  • A list of 10 prescription drugs (at least one generic and one brand name) on which the State spends significant health care dollars and for which DHVA’s net cost has increased by 50 percent or more over the past five years or 15 percent or more over the previous calendar year (ranked from the greatest to least net cost increase).

The lists must be submitted to the Green Mountain Care Board annually on or before June 1. The most recent lists may be viewed here and here.

 18 V.S.A. § 4635 requires that each health insurer with more than 5,000 covered lives in Vermont for major medical health insurance annually create a list of 10 prescription drugs (at least one generic and one brand name) 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.  The health insurer must rank the drugs on the list from those with the greatest increase in net 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 indicate each of the drugs on the list that the health insurer considers to be specialty drugs.

Once identified, the GMCB must provide a list of the drugs, including the percentage of wholesale acquisition cost increase for each, to the Office of the Attorney General, and make the information available to the public on the GMCB website.

All Drug Lists:

 

For additional information, contact Susan Barrett, Executive Director

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Green Mountain Care Board
144 State Street
Montpelier, Vermont 05602
802-828-1972

Public Information Requests To:

sebastian.arduengo@vermont.gov or conor.kennedy@vermont.gov

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