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Committee reviews draft of H.577 to credit discount-card payments toward deductibles
Summary
A committee previewed amendments to H.577 that would require insurers and pharmacy benefit managers to credit amounts paid using Vermont prescription drug discount cards toward insured individuals’ deductibles and out-of-pocket maximums and to provide a proof-of-payment process; testimony is scheduled for tomorrow.
Jen Carby of the Office of Legislative Council walked a legislative committee through a strike-all amendment to H.577, an act to establish the Vermont prescription drug discount card program, and explained how the draft would require insurers and pharmacy benefit managers (PBMs) to attribute amounts paid using discount cards toward covered individuals’ deductibles and annual out-of-pocket maximums. Carby said the amendment also adds a reporting requirement that the treasurer’s annual report include the balance in the Vermont prescription drug discount card program fund.
The draft clarifies three core points. First, it explicitly defines 'cash price' to include the lowest price an individual can obtain using a drug discount card so those payments count toward deductible and out-of-pocket limits. Second, the amendment repeats existing statutory limitations: attribution applies only for certain prescription drugs (for example, where no generic or interchangeable biological product exists or where access was obtained through prior authorization or step therapy) and applies to high-deductible health plans only insofar as doing so would not disqualify the plan from health savings account eligibility under federal law. Third, the bill would require insurers or PBMs to make a downloadable proof-of-payment form available on their websites and to provide covered individuals at least annual notice that they are responsible for submitting proof if they want those payments attributed to their out-of-pocket totals.
Carby described the proof-of-payment element as modeled on Connecticut’s law, explaining that the insurer or PBM must "make readily available on its website a downloadable proof of payment form" and may offer another mechanism for submission if it chooses. When asked about accessibility concerns for elderly people who might not be able to download and submit forms, Carby said the Connecticut model used a downloadable form as the default and allowed insurers to provide an alternative electronic submission method; a committee member noted that Blue Cross already posts a fillable PDF and an online submission portal.
The committee did not vote on the amendment. Members were told there will be testimony on H.577 at the next meeting; no final action was taken during the preview.
Next steps: testimony is scheduled for tomorrow and committee members indicated they will continue reviewing and amending the language before any formal vote.
