The Senate Finance Committee completed its work on a prescription drug bill this week, approving legislation that would place pharmacy benefit managers (PBM’s) under state regulation and restrict drug manufacturer promotions.

S.115 would require PBMs to provide health plans with all financial and utilization information requested by the insurer, notify the insurer of any conflicts of interest, pass through any manufacturer rebates or discounts, and allow audits for verification.

The bill also would require pharmaceutical manufacturers to provide transparency in prescription drug pricing, limit fraudulent advertising to consumers and physicians, and disclose information on their education programs. The bill also contains provisions for evidence-based education and restrictions on prescription drug data for marketing purposes.

S.115 will be referred to the Senate Health and Welfare Committee for review this week before going before the full Senate for approval.

The Senate Health and Welfare Committee also is poised to approve a bill (S.39) to define naturopaths as primary care physicians and mandate health plan reimbursement for naturopathic services. The committee may act on a bill to expand Vermont’s medical marijuana law to patients suffering chronic pain. The current law allows use by patients with certain life-threatening illnesses.

The Senate Health and Welfare Committee will hold a public hearing at the State House this Tuesday from 6:30PM to 9:00PM on “patient-directed dying.”

Meanwhile, the House Health Care Committee remains focused on issues related to full implementation of the state’s Blueprint for Health and chronic care initiative. BCBSVT described its pay for quality provider reimbursement program for the committee on Wednesday. The committee was very interested in the BCBSVT experience with its pilot program to provide higher reimbursement for physicians’ practices that adopt proven strategies to effectively treat chronic illnesses.

The House committee intends to have a bill crafted within the next week or two to advance the transformation of the state’s delivery system in accordance with the Blueprint.

The deadline for introduction of new bills is February 28 and House and Senate Committees have until mid-March to act on bills to be assured that the other chamber will consider those proposals this session. This “crossover date” provides an orderly process for consideration of bills as they cross from one chamber to the other.

This week, the Senate Finance Committee will discuss S.62, a bill that would allow a divorced spouse to continue on the former spouse’s group health plan without an additional premium. This bill was considered but not enacted last session. Instead, a summer study was ordered. However, there was no consensus among the study group so the bill is back this year sponsored by a member of the committee.

Also, the Office of Professional Regulation is preparing amendments to the licensing act for physical therapists and athletic trainers that would impose a mandate on health insurers to reimburse athletic trainers for their services.

New Bills of Interest:

S.114 Introduced by Senator Cummings of Washington District and others

This bill proposes to establish the goal of fully integrating mental health and substance abuse services with other health services.

S.115 Introduced by the Committee on Finance

This bill proposes to increase transparency in prescription drug information and pricing by limiting fraudulent advertising of prescription drugs to consumers and health care professionals, requiring notice to clients by PBMs that certain types of contracts are available, strengthening the Medicaid preferred drug list, establishing an evidence-based education program, providing additional pricing information to the Medicaid program from drug manufacturers, requiring disclosure of education programs funded by drug manufacturers, and providing enforcement for prescription drug provisions under the Consumer Fraud Act.

S.125 Introduced by Senator White of Windham County and others

This bill proposes to establish a statewide association captive insurance company and require all health providers and facilities to obtain medical malpractice insurance from this captive insurance company.

S.129 Introduced by Senator Illuzzi of Essex-Orleans District

This bill proposes to specify first and third party rights of action for cases relating to unfair claim settlement practices of insurers.

H.376 Introduced by representative Koch of Barre Town and others

This bill proposes to require a health plan to pay by electronic funds transfer within eight days any prescription drug claim submitted electronically.

H.379 Introduced by Representatives Milkey of Brattleboro and Donahue of Northfield

This bill proposes to allow Christian Science nurses to practice Christian Science nursing without being in violation of Vermont law that regulates the practice of nursing. 

H.380 Introduced by Representative Donahue of Northfield

This bill proposes to amend hospital reporting and licensing requirements; provide hospitals with greater flexibility in how community needs assessments are conducted; eliminate mandatory biannual revisions to the health resource allocation plan; require the public oversight commission to make recommendations regarding revisions to the health resource allocation plan; amend the certificate of need laws; and provide for the regulation of mobile health screening facilities.

H.384 Introduced by Representative Fisher of Lincoln and others

This bill proposes to allow Vermonters to receive coverage under the Vermont health access plan (VHAP) retroactively to cover medical care recently received.

For more information on legislative proposals, visit the Blue Cross and Blue Shield of Vermont website at www.bcbsvt.com or call Leigh Tofferi at (802) 223-6131 or Kathy Parry at (802) 371-3205. If you wish to discontinue receiving these updates or know of anyone else who would like to receive it, please call Kathy Parry or send an e-mail to webmail@bcbsvt.com