§ 3612. Prohibited practices
(a) A participation contract between a pharmacy benefit manager and a pharmacist shall not prohibit, restrict, or penalize a pharmacy or pharmacist in any way from disclosing to any covered person any health care information that the pharmacy or pharmacist deems appropriate, including:
(1) the nature of treatment, risks, or alternatives to treatment;
(2) the availability of alternate therapies, consultations, or tests;
(3) the decision of utilization reviewers or similar persons to authorize or deny services;
(4) the process that is used to authorize or deny health care services; or
(5) information on financial incentives and structures used by the health insurer.
(b) A pharmacy benefit manager shall not prohibit a pharmacy or pharmacist from:
(1) discussing information regarding the total cost for pharmacist services for a prescription drug;
(2) providing information to a covered person regarding the covered person’s cost-sharing amount for a prescription drug;
(3) disclosing to a covered person the cash price for a prescription drug; or
(4) selling a more affordable alternative to the covered person if a more affordable alternative is available.
(c) A pharmacy benefit manager contract with a participating pharmacist or pharmacy shall not prohibit, restrict, or limit disclosure of information to the Commissioner, law enforcement, or State and federal government officials, provided that:
(1) the recipient of the information represents that the recipient has the authority, to the extent provided by State or federal law, to maintain proprietary information as confidential; and
(2) prior to disclosure of information designated as confidential, the pharmacist or pharmacy:
(A) marks as confidential any document in which the information appears; and
(B) requests confidential treatment for any oral communication of the information.
(d) A pharmacy benefit manager shall not terminate a contract with or penalize a pharmacist or pharmacy due to the pharmacist or pharmacy:
(1) disclosing information about pharmacy benefit manager practices, except for information determined to be a trade secret under State law or by the Commissioner, when disclosed in a manner other than in accordance with subsection (c) of this section; or
(2) sharing any portion of the pharmacy benefit manager contract with the Commissioner pursuant to a complaint or query regarding the contract’s compliance with the provisions of this chapter.
(e)(1) A pharmacy benefit manager shall not require a covered person purchasing a covered prescription drug to pay an amount greater than the lesser of:
(A) the cost-sharing amount under the terms of the health benefit plan;
(B) the maximum allowable cost for the drug; or
(C) the amount the covered person would pay for the drug if the covered person were to pay the pharmacy’s usual and customary cash price, after application of any known discounts, instead of using the drug benefit; provided, however, that as used in this subdivision (C), the term “discount” does not include a prescription drug discount card or other third-party prescription drug benefit program.
(2)(A) A pharmacy benefit manager shall attribute any amount paid by or on behalf of a covered person, including any third-party payment, financial assistance, discount, discount card, coupon, or any other reduction in out-of-pocket expenses made by or on behalf of a covered person for prescription drugs, regardless of whether the person purchased the drug with or without using coverage for the drug under any health benefit plan, toward:
(i) the out-of-pocket limits for prescription drug costs under 8 V.S.A. § 4092;
(ii) the covered person’s deductible, if any; and
(iii) to the extent not inconsistent with Sec. 2707 of the Public Health Service Act, 42 U.S.C. § 300gg-6, the annual out-of-pocket maximums applicable to the covered person’s health benefit plan.
(B) The provisions of subdivision (A) of this subdivision (2) relating to a third-party payment, financial assistance, discount, coupon, or other reduction in out-of-pocket expenses made on behalf of a covered person shall only apply to a prescription drug:
(i) for which there is no generic drug or interchangeable biological product, as those terms are defined in section 4601 of this title; or
(ii) for which there is a generic drug or interchangeable biological product, as those terms are defined in section 4601 of this title, but for which the covered person has obtained access through prior authorization, a step therapy protocol, or the pharmacy benefit manager’s or health benefit plan’s exceptions and appeals process.
(C) The provisions of subdivision (A) of this subdivision (2) shall apply to a high-deductible health plan only to the extent that it would not disqualify the plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.
(D) In order to facilitate the appropriate attribution of amounts paid by or on behalf of a covered person pursuant to subdivision (A) of this subdivision (2) for a covered person who purchases a prescription drug without using the prescription drug coverage available for the drug under the covered person’s health benefit plan, the pharmacy benefit manager shall:
(i) make readily available on its website a downloadable proof of payment form for a covered person to use to submit proof of the actual amount that the covered person paid for the drug; and
(ii) provide notice to all covered persons at least annually that they are responsible for providing proof of payment using a downloadable proof of payment form or another mechanism, if the pharmacy benefit manager elects to make another mechanism available for submitting proof of payment in addition to the downloadable form, in order to have their spending properly attributed to their out-of-pocket limits, deductible, and out-of-pocket maximums as set forth in subdivision (A) of this subdivision (2).
(f) A pharmacy benefit manager shall not conduct or participate in spread pricing in this State, which means that a pharmacy benefit manager must ensure that the total amount required to be paid by a health benefit plan and a covered person for a prescription drug covered under the plan does not exceed the amount paid to the pharmacy for dispensing the drug. (Added 2023, No. 127 (Adj. Sess.), § 1, eff. July 1, 2024; amended 2025, No. 132 (Adj. Sess.), § 3, eff. July 1, 2026.)