Lawmakers concur with Senate amendment delaying outpatient drug-price cap in H.266

Legislators voted to concur with a Senate amendment to H.266 that strikes a temporary mid-2025 cap and leaves in place a limitation on outpatient-administered prescription drug charges tied to 20% of the drugs' average sales price (ASP) effective Jan. 1, 2026, while preserving carve-outs for critical access hospitals and an appeal path to the Green Mountain Care Board.

The change removes a provision that would have required a lower 30% ASP cap for certain higher-priced drugs from July 1 through Dec. 31, 2025, and instead delays the start of the outpatient-drug cap until Jan. 1, 2026. Jen Harvey, counsel in the Office of Legislative Council, summarized the amendment on the floor: "the Senate concurred in the House in your proposal of amendment on H 2 66 ... striking out section 5" and described the effect as leaving the limitation in place with a Jan. 1, 2026, effective date.

Why it matters: The change affects hospitals' charging for outpatient-administered drugs, the timing of budget and rate calculations for insurers and hospitals, and existing protections for federally qualified health centers (FQHCs) and critical access hospitals. Committee members and other lawmakers focused on how the change would interact with insurer rate filings and hospital fiscal-year planning.

Key details: Under the version lawmakers reviewed, section 4 sets a 20% ASP limit on outpatient-administered drugs for drugs that hospitals charged above that level as of April 1 and locks in an ASP percentage for others; that provision is effective Jan. 1, 2026. Section 5, which lawmakers removed in the Senate amendment, had applied a 30% ASP limitation from July through December 2025 for certain higher-priced drugs and included largely duplicated protections that remain elsewhere in the text.

Timing and budget effects were a central topic. Committee members noted that qualified health plans (QHPs) submit budget requests in July and receive approvals in August; insurers had already submitted rates for the 2026 plan year but expected to make actuarial modifications. As one legislator summarized, the hospitals' fiscal year begins in October, meaning budgets would reflect three quarters of any provision that took effect in January 2026.

Supporters of the amendment said the change provides hospitals and regulators time to adjust operationally and to use existing appeal processes. A lawmaker who identified the amendment sponsor as Sen. Terry Williams of Brandon explained the rationale: giving hospitals an opportunity to present their case to the Green Mountain Care Board and permitting that board to make adjustments "if necessary." Jen Harvey added that the protections and the carve-out for critical access hospitals "all of that remains."

Opponents or hesitant lawmakers emphasized the urgency of addressing pressures in the health-care system; one lawmaker said she would "vote for this kicking and screaming," urging hospitals to take action in coming months to meet the bill's goals and protect access.

Action taken: Members conducted a voice/straw poll on whether to concur with the Senate proposal of amendment to the House proposal of amendment on H.266. The recorded result of that poll was 10-0-1 in favor of concurrence. The poll result was announced on the record; no formal roll-call motion mover or seconder was recorded in the transcript.

What was not decided or remains unclear from the session: The committee did not adopt any additional amendments from the floor at that stage; whether the concurrence will be followed by formal final passage or further procedural steps (conference committee, additional votes) was not resolved in the excerpted discussion.

The matter will affect hospitals, insurers and consumers as the effective date and ASP limits are implemented and as the Green Mountain Care Board and insurers incorporate the changes into rate reviews and budget orders.