Senate agrees to delay rollout of H.266 infusion drug price cap, approves house amendment 20-10

The Vermont Senate on Friday voted 20-10 to concur in the House proposal of amendment to H.266 — a bill that would limit hospital charges for certain outpatient infusion prescription drugs — adopting a further proposal of amendment that delays the measure’s full implementation until Jan. 1, 2026.

Senator from Chittenden, reporting for the Senate Health and Welfare Committee, said the measure targets high markups on drugs administered in outpatient and office infusion settings and offered a phased-in reference-based cap tied to the federal average sales price published by the Centers for Medicare & Medicaid Services. “Folks are paying almost $50,000 a year” for a family of four’s silver plan and “the maximum out-of-pocket expense … approaches $20,000,” the senator said in describing why the committee recommended action.

The bill as discussed would set a phase-in cap of 130% of Medicare’s average sales price for an interim period and then a 120% cap going forward on hospital claims for specified outpatient infusion drugs. The House proposal and the version debated on the floor also prohibit hospitals from balance-billing patients for amounts above the statutory cap and bar hospitals from increasing other charges “in an effort to offset revenue reduced as a result of implementing this section,” language proponents said is meant to prevent revenue-shifting.

Supporters said the change is intended to reduce private insurance premiums and employers’ health costs. The Senate floor report cited estimates that school districts could see about a 3% reduction in premiums (described as roughly $12 million “off the top”) and that qualified health plans could see about a 4% premium reduction if the pricing changes were implemented. “This is an opportunity to look at and to reduce prescription drug costs that have been a cause for increased premiums,” the Senator from Chittenden said.

Opponents warned of financial harm to larger hospitals and potential service reductions. The Senator from Essex warned that hospitals need margin to maintain staffing and services in rural areas and said local hospitals in the senator’s district urged opposition. The Senator from Rutland said Rutland Regional Medical Center faces a roughly $16 million revenue shortfall and supported the adopted amendment to give hospitals more time to prepare.

Senators on both sides emphasized that critical access hospitals are exempted from the cap in the enacted language; multiple speakers credited that exemption as an important protection for small rural facilities. The Senate Health and Welfare Committee reported that it supported the House proposal and would not stand in the way of the amendment if it helped the bill move forward.

On procedure, the Senate adopted the further proposal of amendment and then moved to suspend rules so the chamber could message H.266 to the House forthwith. A separate floor motion to suspend the rules to take up S.45 for immediate action later led to appointment of a conference committee on that bill.

Votes at a glance • H.266 — Senate concur in House proposal of amendment with further proposal of amendment (motion to concur with further proposal of amendment): passed, ayes 20, nays 10. Division requested; tally announced as 20–10.

What the bill would do (as discussed on the floor) • Limit hospital reimbursement claims for certain prescription drugs administered in outpatient or office infusion settings to a percentage of Medicare’s published average sales price (phase-in described as 130% then 120%). • Prohibit balance billing and prohibit hospitals from raising unrelated charges to offset revenue losses resulting from the cap. • Exempt critical access hospitals from the outpatient infusion drug cap.

Next steps and context The Senate voted to message its actions on H.266 to the House. Supporters argued the measure is a quick step to reduce health insurance costs that have been rising for years; opponents urged caution to avoid harming hospital finances and services. The Green Mountain Care Board was identified repeatedly on the floor as the entity that would oversee hospital budgets and could consider adjustments as the cap and reference-based pricing changes take effect.

Sources and attributions Floor debate and committee reporting on May 30, 2025, Vermont Senate session. Quotes and numerical examples in this article are drawn from floor remarks attributed to “Senator from Chittenden,” and other senators identified on the floor.