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The Vermont Statutes Online



Title

08

:
Banking and Insurance






Chapter

107

:
HEALTH INSURANCE






Subchapter

001
:
GENERALLY










 

§

4089j. Retail pharmacies; filling of prescriptions

(a) A health

insurer and pharmacy benefit manager doing business in Vermont shall permit a

retail pharmacist licensed under 26 V.S.A. chapter 36 to fill prescriptions in

the same manner and at the same level of reimbursement as they are filled by

mail order pharmacies with respect to the quantity of drugs or days' supply of

drugs dispensed under each prescription.

(b) As used in

this section:

(1) "Health

insurer" is defined by 18 V.S.A. § 9402.

(2) "Pharmacy

benefit manager" means an entity that performs pharmacy benefit

management. "Pharmacy benefit management" means an arrangement for

the procurement of prescription drugs at negotiated dispensing rates, the

administration or management of prescription drug benefits provided by a health

insurance plan for the benefit of beneficiaries, or any of the following

services provided with regard to the administration of pharmacy benefits:

(A) mail service

pharmacy;

(B) claims

processing, retail network management, and payment of claims to pharmacies for

prescription drugs dispensed to beneficiaries;

(C) clinical

formulary development and management services;

(D) rebate

contracting and administration;

(E) certain

patient compliance, therapeutic intervention, and generic substitution

programs; and

(F) disease

management programs.

(c) This section

shall apply to Medicaid and any other public health care assistance program.

(Added 2003, No. 122 (Adj. Sess.), § 128e; amended 2013, No. 79, § 9, eff. Jan.

1, 2014.)