Committee reviews technical amendments to H.611 to remove 340B rebate ban, delay doula coverage start and clean up VPharm language
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Summary
Legislative staff presented a strike‑all amendment to H.611 that would (1) remove a state prohibition on offering 340B pricing as rebates, responding to federal preemption rulings and litigation; (2) push the earliest start of Medicaid doula coverage to July 1, 2027, tied to CMS approval; and (3) delete a MAGI reference for the VPharm pharmacy assistance program as a statutory cleanup. Agency and advocate witnesses said the timing and technical fixes are feasible; no votes were recorded.
Jen Carvey of the Office of Legislative Council told the committee the draft is currently written as a strike‑all amendment and includes a new section that would remove a provision enacted last session concerning 340B drug pricing. "There was a subsection which says a manufacturer or its agent shall offer or otherwise make available 340B drug pricing to a 340B covered entity or its contract pharmacy in the form of a discount at the time of purchase and shall not offer or otherwise make available 340B drug pricing in the form of a rebate," Carvey said, and courts have found parts of the 340B provisions enacted last year subject to federal preemption and litigation.
Carvey told members that two federal courts have ruled the authority to regulate the rebate/discount issue lies with the federal government and that the language is already the subject of a preliminary injunction in the U.S. District Court in Vermont. To reduce the risk that the state statute will be invalidated by litigation, the draft amendment would remove the rebate prohibition from state law.
Committee members also discussed a separate technical change in H.611 affecting Medicaid coverage for doulas. Carvey explained the bill would move the deadlines tied to a state plan amendment (SPA) so that coverage would not begin before July 1, 2027. "So it would not start before 07/01/2027, even if they sought the state plan amendment tomorrow," Carvey said.
Ashley Berliner, director of Medicaid policy for the Agency of Human Services, told the committee the revised timeline is feasible if staff have time to draft and submit the SPA, obtain CMS approval, and complete IT work in the state's Medicaid management information system to register doulas as a provider type and set billing and rates. "We think that July 2027 is achievable," Berliner said. She added that recent discussions with doula advocates about requiring a referring provider to make sure services are appropriate have eased some of the agency's program‑integrity concerns and make CMS approval more likely.
Separately, Emma Zavas, a health policy analyst with the Office of the Healthcare Advocate, urged the committee to delete a statutory reference to MAGI (modified adjusted gross income) as the financial methodology for VPharm, the state's pharmacy assistance program for Vermonters with Medicare. Zavas said MAGI was never implemented for VPharm and that the language is a lingering technical provision from older Vermont Health Access Plan rules that were mostly repealed. "We are suggesting that in H.611 you consider deleting a reference to MAGI," she said, calling the change a "short and sweet" cleanup.
Department staff present signaled they had coordinated on the MAGI change and did not object. No formal motions or roll‑call votes occurred during the discussion; the committee recessed for a 10‑minute break to allow staff to continue refining the draft language and to pursue remaining technical changes with agency partners.