Registration Information For Pharmacy Benefit Managers (PBM)

Registering with the State of Vermont

All Pharmacy Benefit Managers (PBMs) with customers who are Vermont residents are required to register on an annual basis—by December 31st—with the State of Vermont. This requirement pertains to comprehensive major medical health benefit plans that may be insured or self-insured, Medicare Supplement, and Medicare Parts C and D. Agencies serving 200 or more Vermont resident members must also report claims in Vermont’s All-Payer Claims Database (APCD), called Vermont Health Care Uniform Reporting and Evaluation system, or VHCURES.

Agencies serving fewer than 200 Vermont residents must register annually but are not required to report to VHCURES.

Currently both annual registration and VHCURES reporting occurs via Onpoint Health Data, GMCB’s contractor for VHCURES data collection, consolidation, and user support. Click the link below to access the State of Vermont Registration Forms in the Onpoint Claims Data Manager.

Onpoint Claims Data Manager

If you are experiencing problems with the registration or need further information about the process, please contact Onpoint Health Data Systems at vt-support@onpointhealthdata.org or by phone at 207-623-2555.

 

PBM Disclosure Form

Under 18 V.S.A. §9472(d), pharmacy benefit managers (PBMs) that provide pharmacy benefit management for health plans in Vermont are required to report to the health insurer, as well as the Department of Financial Regulation (DFR) and the Green Mountain Care Board (GMCB) (collectively, “the State”) on the aggregate amount the pharmacy benefit manager retained on all claims charged to the health insurer for prescriptions filled during the preceding calendar year in excess of the amount the pharmacy benefit manager reimbursed pharmacies. This disclosure form has been developed to provide a standardized and consistent means by which PBMs may implement this statutory requirement with respect the disclosures required to the State. This form does not contemplate nor make recommendations on how PBMs may seek to fulfill their obligation to report this information to the health insurers they conduct business with. This form is due annually on July 1 for the prior calendar year. For the purposes of this form, the disclosure information provided should be pertinent to:

  • Health insurers that are licensed in Vermont.
  • PBM services provided to Vermont members only.
  • Claims charged for the date range of January 1 to December 31 for the calendar year preceding the July 1 due date for the report.

PBMs should complete this PBM Disclosure Form, convert it to a portable document format (PDF), and route the completed form, or any questions regarding it, to gmcb.data@vermont.gov and dfr.complic@vermont.gov.

 

Registered Pharmacy Benefit Managers, as of November 13, 2018

 

General questions or inquiries related to VHCURES stewardship and governance can be sent to GMCB at gmcb.data@vermont.gov.

 

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