{"data":{"id":"us-vt/18-v.s.a.-3612","jurisdiction":"us-vt","citation":"18 V.S.A. § 3612","heading":"Prohibited practices","body":"(a) A participation contract between a pharmacy benefit manager and a pharmacist shall not prohibit, restrict, or penalize a pharmacy or pharmacist in any way from disclosing to any covered person any health care information that the pharmacy or pharmacist deems appropriate, including:\n(1) the nature of treatment, risks, or alternatives to treatment;\n(2) the availability of alternate therapies, consultations, or tests;\n(3) the decision of utilization reviewers or similar persons to authorize or deny services;\n(4) the process that is used to authorize or deny health care services; or\n(5) information on financial incentives and structures used by the health insurer.\n(b) A pharmacy benefit manager shall not prohibit a pharmacy or pharmacist from:\n(1) discussing information regarding the total cost for pharmacist services for a prescription drug;\n(2) providing information to a covered person regarding the covered person’s cost-sharing amount for a prescription drug;\n(3) disclosing to a covered person the cash price for a prescription drug; or\n(4) selling a more affordable alternative to the covered person if a more affordable alternative is available.\n(c) A pharmacy benefit manager contract with a participating pharmacist or pharmacy shall not prohibit, restrict, or limit disclosure of information to the Commissioner, law enforcement, or State and federal government officials, provided that:\n(1) the recipient of the information represents that the recipient has the authority, to the extent provided by State or federal law, to maintain proprietary information as confidential; and\n(2) prior to disclosure of information designated as confidential, the pharmacist or pharmacy:\n(A) marks as confidential any document in which the information appears; and\n(B) requests confidential treatment for any oral communication of the information.\n(d) A pharmacy benefit manager shall not terminate a contract with or penalize a pharmacist or pharmacy due to the pharmacist or pharmacy:\n(1) disclosing information about pharmacy benefit manager practices, except for information determined to be a trade secret under State law or by the Commissioner, when disclosed in a manner other than in accordance with subsection (c) of this section; or\n(2) sharing any portion of the pharmacy benefit manager contract with the Commissioner pursuant to a complaint or query regarding the contract’s compliance with the provisions of this chapter.\n(e)(1) A pharmacy benefit manager shall not require a covered person purchasing a covered prescription drug to pay an amount greater than the lesser of:\n(A) the cost-sharing amount under the terms of the health benefit plan, as determined in accordance with subdivision (2) of this subsection (e);\n(B) the maximum allowable cost for the drug; or\n(C) the amount the covered person would pay for the drug, after application of any known discounts, if the covered person were paying the cash price.\n(2)(A) A pharmacy benefit manager shall attribute any amount paid by or on behalf of a covered person under subdivision (1) of this subsection (e), including any third-party payment, financial assistance, discount, coupon, or any other reduction in out-of-pocket expenses made by or on behalf of a covered person for prescription drugs, toward:\n(i) the out-of-pocket limits for prescription drug costs under 8 V.S.A. § 4092;\n(ii) the covered person’s deductible, if any; and\n(iii) to the extent not inconsistent with Sec. 2707 of the Public Health Service Act, 42 U.S.C. § 300gg-6, the annual out-of-pocket maximums applicable to the covered person’s health benefit plan.\n(B) The provisions of subdivision (A) of this subdivision (2) relating to a third-party payment, financial assistance, discount, coupon, or other reduction in out-of-pocket expenses made on behalf of a covered person shall only apply to a prescription drug:\n(i) for which there is no generic drug or interchangeable biological product, as those terms are defined in section 4601 of this title; or\n(ii) for which there is a generic drug or interchangeable biological product, as those terms are defined in section 4601 of this title, but for which the covered person has obtained access through prior authorization, a step therapy protocol, or the pharmacy benefit manager’s or health benefit plan’s exceptions and appeals process.\n(C) The provisions of subdivision (A) of this subdivision (2) shall apply to a high-deductible health plan only to the extent that it would not disqualify the plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.\n(f) A pharmacy benefit manager shall not conduct or participate in spread pricing in this State, which means that a pharmacy benefit manager must ensure that the total amount required to be paid by a health benefit plan and a covered person for a prescription drug covered under the plan does not exceed the amount paid to the pharmacy for dispensing the drug.","path":["Title 18: Health","Chapter 077: Pharmacy Benefit Managers","Subchapter 002: PHARMACY BENEFIT MANAGER LICENSURE AND REGULATION"],"source_url":"https://legislature.vermont.gov/statutes/section/18/077/03612","current_through":"2025 session","vintage":"","retrieved_at":"2026-09-05T17:17:02Z","sha256":"8963e543e7f3dddb9fc1a088d7e01c253f3480a5da71803f621f865ccdbb2f4e","source_id":"us-vt","stale":false,"prev":"us-vt/18-v.s.a.-3611","next":"us-vt/18-v.s.a.-3613"},"notice":"GroundRules: Original legal text. Not legal advice."}