An act relating to establishing the Vermont Prescription Drug Discount Card Program

The official version allowed the State Treasurer to charge reasonable fees to participants to defray program costs, with a carve-out from 32 V.S.A. section 603. The unofficial version removes this fee authority entirely and instead requires that monies received from transfers, gifts, grants, donations, or cooperative arrangements be deposited in the Financial Literacy and Economic Empowerment Trust Fund (32 V.S.A. section 111) to defray program costs.

The annual report requirement in Section 1(e) now includes a new element: the Treasurer must report on 'the impact, if any, of the Program on the viability of Vermont's pharmacies.' This adds oversight focused on whether the discount card program could harm local pharmacy businesses.

The implementation report due January 15, 2027 no longer requires the Treasurer to include 'any fees to be charged to participants,' consistent with the removal of fee authority from the program's funding structure.

A new Section 4692 establishes the 'Vermont Prescription Drug Discount Card Program Fund' as a special fund administered by the State Treasurer. The fund is funded by General Assembly appropriations, federal or state transfers, participant fees, and gifts/grants/donations. Unexpended balances carry forward.

Section 4691(c) was changed from requiring that program monies be deposited in the Financial Literacy and Economic Empowerment Trust Fund to allowing the Treasurer to charge reasonable fees to defray program costs, with the amount and method of collection determined by the Treasurer based on actual costs.

The annual report requirement in Section 4691(e) now additionally requires reporting 'the balance in the Vermont Prescription Drug Discount Card Program Fund.'

The implementation report due January 15, 2027 (Section 4) now must include 'any fees to be charged to participants' in addition to recommendations and cost estimates.

Section 1(c) was changed from granting the Treasurer explicit authority to charge reasonable fees (with a carve-out from 32 V.S.A. section 603) to a broader statement that monies received from transfers, gifts, grants, donations, or other sources may be used to defray program costs. This removes the direct fee-charging power.

New Section 3a amends 32 V.S.A. section 111 to allow the Financial Literacy and Economic Empowerment Trust Fund to be used to defray costs of administering the Vermont Prescription Drug Discount Card Program, providing an alternative funding source in place of participant fees.

The annual report requirement in Section 1(e) now includes 'the impact, if any, of the Program on the viability of Vermont's pharmacies' as a required element, adding oversight regarding potential harm to local pharmacies.

The implementation report in Section 4 no longer requires the Treasurer to report on 'any fees to be charged to participants,' consistent with the removal of explicit fee authority from the program.

The dedicated Vermont Prescription Drug Discount Card Program Fund (former Sec. 4692) is eliminated entirely, along with its revenue sources (appropriations, federal transfers, fees, gifts, grants, donations).

The provision allowing the State Treasurer to charge reasonable fees to participants to defray program costs is removed.

Program monies from transfers, gifts, grants, donations, or cooperative arrangements are now directed into the existing Financial Literacy and Economic Empowerment Trust Fund (32 V.S.A. sec. 111) rather than a new dedicated fund.

New Sec. 3a amends 32 V.S.A. sec. 111 to explicitly authorize use of the Financial Literacy and Economic Empowerment Trust Fund to defray costs of administering the Vermont Prescription Drug Discount Program.

New Sec. 2 amends 8 V.S.A. sec. 4093 to require health insurers and PBMs to count amounts paid by or on behalf of covered individuals (including third-party payments, financial assistance, discounts, discount cards, coupons) toward out-of-pocket limits, deductibles, and annual out-of-pocket maximums. This applies only to drugs with no generic or interchangeable biological product available, or where access was obtained through prior authorization, step therapy, or exceptions/appeals. For high-deductible plans, the rule applies only to the extent it does not disqualify HSA eligibility.

New Sec. 2 also requires insurers and PBMs to make a downloadable proof of payment form available on their website and to provide annual notice to covered individuals that they must submit proof of payment to have spending properly attributed to their cost-sharing limits.

New Sec. 3 amends 18 V.S.A. sec. 3612 (Prohibited Practices) to prohibit PBMs from requiring a covered person to pay more than the lesser of: the plan's cost-sharing amount, the maximum allowable cost for the drug, or the pharmacy's usual and customary cash price after known discounts (excluding discount card programs).

New Sec. 3 also requires PBMs to attribute third-party payments toward out-of-pocket limits, deductibles, and annual maximums, with the same generic-availability and HSA limitations as in Sec. 2, plus proof of payment form and annual notice requirements.

The implementation report due January 15, 2027 no longer includes a requirement to report on fees to be charged to participants, consistent with the removal of fee authority.