| Rule Number: |
24P003 |
| Title: |
VPharm Coverage. |
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Type:
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Standard |
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Status:
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Adopted |
| Agency: |
Agency of Human Services
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| Legal Authority: |
3 V.S.A. § 801(b)(11); 33 V.S.A. § 2081(a) |
| Summary:
| This proposed rulemaking amends VPharm rule 5450 titled "Coverage" which establishes coverage for the VPharm program. This VPharm Coverage rule was last amended effective February 25, 2012. This amendment aligns with federal and state guidance and law, improves clarity, and makes technical corrections. Certain content, such as 5450.1 Rebate or Price Discount, has been removed as it was redundant with language that exists in state statute. Substantive revisions include: expanding drug coverage available under VPharm 2 and VPharm 3 to be equivalent to the drug coverage available under VPharm 1 and the Medicaid program, as authorized through Vermont's Global Commitment to Health 1115 Demonstration waiver effective July 1, 2022. |
| Persons Affected:
| VPharm beneficiaries; Agency of Human Services including its Departments; hospitals; health law, policy, and related advocacy and community-based organizations and groups including Vermont Legal Aid; health care providers; and pharmacies. |
| Economic Impact:
| The expansion of drug coverage available under VPharm 2 and VPharm 3 has been implemented and was effective July 1, 2022 under the authority of the Global Commitment to Health 1115 waiver. Public notice was conducted through the Global Commitment Register (see GCR 22-046) on June 29, 2022. The estimated gross annualized budget impact was $24,397. In expanding drug coverage under VPharm 2 and VPharm 3 to be equivalent to the drug coverage available under VPharm 1 and the Medicaid program, VPharm members will experience lower out-of-pocket costs as they will be able to receive $1/$2 copays for more drugs through VPharm. There is no impact to members with VPharm 1.
Other rule revisions do not increase or lessen an economic burden on any person or entity including no impact on the State's gross annualized budget in Fiscal Year 2024. The changes and amendments conform the rule with current practice and changes to Vermont's Global Commitment to Health 1115 waiver that have already been implemented. |
| Posting date: |
Jan 24,2024 |
| Information for Contact # 1 |
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Level:
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Primary
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| Name: |
Ashley Berliner |
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Agency:
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Department of Vermont Health Access, Agency of Human Services
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| Address: |
280 State Drive |
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| City: |
Waterbury |
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| State: |
VT |
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| Zip: |
05671-1000 |
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| Telephone: |
802-578-9305 |
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| Fax: |
802-241-0450 |
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Email: |
ahs.medicaidpolicy@vermont.gov
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| Website Address: |
https://humanservices.vermont.gov/rules-policies/health-care-rules
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| Information for Contact # 2 |
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Level:
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Secondary
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| Name: |
Danielle Fuoco |
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Agency:
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Department of Vermont Health Access, Agency of Human Services
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| Address: |
280 State Drive, Center Building |
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| City: |
Waterbury |
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| State: |
VT |
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| Zip: |
05671 |
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| Telephone: |
802-585-4265 |
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| Fax: |
802-241-0450 |
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Email: |
danielle.fuoco@vermont.gov
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