Green Mountain Care Board outlines options to curb prescription costs, plans final report next January

Green Mountain Care Board Director Catherine O'Neil told a legislative panel that the board is studying a range of tools to address rising prescription drug costs and expects to issue a final report with recommendations next January.

The preliminary report submitted in January offers a landscape review of strategies other states are using, O'Neil said, and the board is now narrowing options and performing deeper analysis to determine what could be feasible for Vermont. "That final report will include recommendations. The preliminary report does not," she said.

The board is carrying out the work under Act 134, passed last year, which directs the Green Mountain Care Board to develop a methodology and framework for regulating prescription drug costs. O'Neil said the board contracted OnPoint Health Data in December to support analytics using the state's all-payer claims database and has subcontracted Horvath Health Policy for policy expertise.

The preliminary report summarizes models other states have adopted. Several states already have Prescription Drug Affordability Boards (PDABs); O'Neil listed Colorado, Maine, Maryland, Minnesota, New Hampshire, New Jersey, Oregon and Washington as examples. She said PDABs vary in authority, staffing and budgets and often take time to ramp up; industry opposition has slowed some boards' early activity.

Board staff also identified other state strategies under consideration nationally: building on the federal Medicare Drug Price Negotiation program to create broader maximum fair price (MFP) limits; expanding market-transparency data collection; caps on insured out-of-pocket costs for specific drugs (Vermont already caps insulin at $100 per 30-day supply); multi-state purchasing pools; and limited programs to support personal importation for defined populations. O'Neil said international importation faces federal approval and implementation hurdles and that Vermont's Agency of Human Services is leading the state's importation program.

O'Neil emphasized the board's analytic priorities: estimating potential savings, measuring administrative burden, and assessing market impacts. She said the board will evaluate how any prescription-drug strategy fits with broader healthcare reform efforts in Vermont.

The board intends to deliver a final report with recommendations in January that will include analysis of feasibility and implementation challenges. The preliminary report remains a landscape review and does not recommend a specific policy.

Questions from legislators ranged from whether state licensure of pharmacy benefit managers (PBMs) is sufficient to broader interventions, to whether bold options—such as restricting vertically integrated PBMs from operating retail pharmacies—would risk access where pharmacies are closing.

O'Neil said staff will continue analysis and return with more detailed options for legislative and executive consideration.

Looking ahead, the board plans targeted analysis of specific mechanisms (PDABs, MFP expansion, additional data collection and other approaches) and a narrowed set of options to test more thoroughly before final recommendations.