| Rule Number: |
25P006 |
| Title: |
Licensing Requirements for Pharmacy Benefit Managers. |
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Type:
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Standard |
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Status:
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Adopted |
| Agency: |
Department of Financial Regulation
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| Legal Authority: |
18 V.S.A. §3611(e), 18 V.S.A. §3603 and 18 V.S.A. Chapter 77. |
| Summary:
| Following the passage of Act 127 in 2024, the Department of Financial Regulation was directed to adopt rules to establish the licensing application, financial and reporting requirements for PBMs. Pharmacy Benefit Managers (PBMs) are intermediaries between health insurance companies and drug manufacturers. They negotiate prescription drug prices with manufacturers and separately, they negotiate the reimbursement payable to pharmacies to dispense the drugs. |
| Persons Affected:
| Pharmacy benefit managers operating in Vermont that provide claim processing services, or other prescription drug services or device services for health benefit plans. Health insurance companies operating in Vermont that engage the services of a pharmacy benefit manager and who are licensed by the Insurance Division of the Department of Financial Regulation. Health plan members in Vermont with prescription drug coverage administered or managed by a pharmacy benefit manager. |
| Economic Impact:
| This rule, in and of itself, is not expected to have an economic impact on pharmacy benefit managers or health insurance companies operating in Vermont. The statute imposed fees and administrative requirements on pharmacy benefit managers and this rule only sets forth the procedure by which a pharmacy benefit manager obtains or renews a pharmacy benefit manager license. The rule's procedural requirements may increase administrative costs on pharmacy benefit managers however, health plan members with prescription drug coverage should benefit from the Department of Financial Regulation's licensing process to help ensure pharmacy benefit managers are competent, trustworthy, and financially responsible. No consumer harm or negative economic impact is anticipated. |
| Posting date: |
Jan 22,2025 |
| Information for Contact # 1 |
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Level:
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Primary
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| Name: |
Susan Morriss, Assistant General Counsel |
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Agency:
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Department of Financial Regulation
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| Address: |
89 Main Street, 3rd Floor |
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| City: |
Montpelier |
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| State: |
VT |
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| Zip: |
05620-3101 |
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| Telephone: |
802-798-6059 |
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| Fax: |
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Email: |
susan.morris@vermont.gov
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| Website Address: |
https://dfr.vermont.gov/about-us/legal-general-counsel/proposed-rules-and-public-comment
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| Information for Contact # 2 |
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Level:
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Secondary
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| Name: |
Dan Raddock, Assistant General Counsel |
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Agency:
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Department of Financial Regulation
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| Address: |
89 Main Street, 3rd Floor |
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| City: |
Montpelier |
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| State: |
VT |
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| Zip: |
05620-3101 |
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| Telephone: |
802-371-8980 |
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| Fax: |
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Email: |
dan.raddock@vermont.gov
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