Vermont Legislature SmartTranscripts:

[Rep. Alyssa Black (Chair)]: Oh, we'll take a long break. Yeah,

[Mike Pieciak (Vermont State Treasurer)]: we'll have something to

[Jenny Harvey (Office of Legislative Counsel)]: do that.

[Rep. Alyssa Black (Chair)]: Welcome back, everyone. It is 01:05, and we are pivoting to H577, where we've made some additional changes. We have some testimony from the treasurer. So if you want to go

[Jenny Harvey (Office of Legislative Counsel)]: ahead, Jen. Great. Good afternoon. Jenny Harvey from the Office of Legislative Counsel. I'm going to put up a new draft. This is draft 2.1. Unlike most other times, I've actually left the yellow highlighting and then added green highlighting for new steps because we went through it pretty quickly, I think, the other day. And so I didn't want wanted to make sure we were focusing on kind of everything that has changed from the bill as introduced. So it still creates the prescription drug discount card program. We still have the new language in here saying that the amount paid for a prescription drug after application of the card by an individual covered by a health insurance plan shall be attributed toward their deductible and out of pocket responsibilities in accordance with provisions that get amended in sections two and three. And then keeping that the addition in the report about the balance in the Vermont Prescription Drug Discount Card Program fund. And we still have the fund, changes there. And then section two, well, first, have the two sections where we were making some changes. This is in the insurance statutes on the filling of prescriptions and what a health insurer or pharmacy benefit manager must permit for a participating network pharmacy. And also what they must not do. There's a list of things they must not do. One of them is exclude any amount paid by or on behalf of a covered individual, including any third party payment, financial assistance, discount, adding in discount card, coupon, or other reduction, regardless of whether the individual purchased the drug with or without using coverage for the drug under any health insurance plan. And then so that's sort of that cost accumulator piece that can't exclude any amount or just beefing up the language a little bit around the discount and also clarifying that it's with or without, which was implied, but now is more explicit with or without using their coverage. So that gets counted toward their out of pocket limits for prescription drug costs, their deductible, and their out of pocket maximums. The rest of that language is the same until we get down here. And we, again, have looked at this, I think, last week, but this is still the yellow part. So this is what the insurer and PBM are directed to do in order to facilitate the appropriate attribution of the amounts paid by or on behalf of the covered individual or someone who purchases the drug without using the coverage available to them under their health insurance plan, the health insurer or PBM or both must make readily available on their website a downloadable proof of payment form for covered individual to use to submit proof of the actual amount they paid and provide notice to all covered individuals at least annually if they are responsible for providing proof of payment using the downloadable proof of payment form or another mechanism if the insurer or PBM chooses to make another mechanism available as well in order to have their spending properly attributed to their out of pocket limits, deductible and out of pocket maximums. Now we get to some of the new stuff. So Section three, still a section that was in the last version of the bill. But now we are playing around a little bit with the language here on what is the maximum amount that a PBM can require a covered person purchasing a covered prescription drug to pay. Because this is where I thought there was some confusion about whether if you use the discount card and that lowered the price, whether that created a max for the PBM if you chose to use your plan because you would have the availability of the plan you get with the Discount Card. So now this would say PBM shall not require a covered person purchasing a covered prescription drug to pay an amount greater than the lesser of the cost sharing amount under the terms of the health benefit plan. And we've just struck the reference to Subdivision two because that gets a little bit more complicated. It's about what gets attributed to the deductible out of pocket, and it sort of confuses the issue here. So they're not more than lesser of their cost sharing amount, the maximum allowable amount cost for the drug, or 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, as used in the Subdivision C, the term discount does not include a prescription drug discount card or other third party prescription drug benefit program. Basically, you're not running it through your insurance, then this piece about the lowest possible cost you could get does not apply to what PBM can charge. Does that

[Rep. Alyssa Black (Chair)]: make sense? But it does still apply if you were just paying the cash price. Yes, right. Which was the original intent of that section.

[Jenny Harvey (Office of Legislative Counsel)]: Right. And so a couple of pieces became clear that some of the various parties and I were all having different reads on what the cash price meant and whether a discount included a discount card. And so given all of that lack of clarity, I thought it was clearest to just say what you want to include and not and and exclude what you don't wanna include.

[Rep. Alyssa Black (Chair)]: And can I add in here that we heard testimony from Department of Financial Regulation over concerns, and he indicated that he was working with our legislative council, And this is the language that came out of it and that there was consensus on this?

[Jenny Harvey (Office of Legislative Counsel)]: Yes, I have worked with DFR, the Office of Healthcare Advocate and the Treasurer's Office. So anybody else has not yet been part of that conversation, but that is who was involved in this in recent their concerns were addressed. Believe their concerns were addressed. Yes. And DFR thought cash price and discount were clear enough to work the way they thought they were working. And I thought that the plain language suggested otherwise, so we should fix the lunch. Thank you for doing that. So then we did not include this language about the cash price that had been originally proposed by the Healthcare Advocates Office. We have worked, I think, these concepts in with the exception that it's not affecting what the PBM can charge, but this language is now not necessary. And then in subdivision two, we're just taking the potentially confusing reference to subdivision one out. So now it requires the PBM to attribute any amount paid by or on behalf of the covered person, including, and then it's the same list as in the previous section about health insurers and PBMs, including any third party payment, financial assistance, discount, discount card, coupon, or other reduction in out of pocket expenses made by or on behalf of a covered person for prescription drugs, regardless of whether the individual purchased the drug with or without using coverage for the drug under any health benefit plan. Actually, I noticed they should probably say person because everything else in this section is about a person even though I like it. And I think Oh, no. And then Oh, it's the same language here about in order to facilitate attribution, blah, blah, blah. Same same language, except it's just for PBMs. And then I think we're yes. And that is the assignment change. Persons. Any questions? Scout all of the highlighting.

[Rep. Alyssa Black (Chair)]: Do you need to do, like, a whole another version? Just need a

[Jenny Harvey (Office of Legislative Counsel)]: clean I just need I'm just gonna do a clean version with person K. Instead of individual there, and I'll do that while you're here in future. Alright.

[Rep. Alyssa Black (Chair)]: Okay. Any questions for Jim on the language? Great. Thank you. We take it off the

[Jenny Harvey (Office of Legislative Counsel)]: Come on, I'll take it down. Yep. Wait.

[Rep. Alyssa Black (Chair)]: Jen, do take the language down? We can see you. Welcome, Chittenden. We can hear you over while she's live.

[Mike Pieciak (Vermont State Treasurer)]: Would be more interesting than listening to me.

[Unidentified Committee Member]: Thanks for

[Rep. Alyssa Black (Chair)]: joining today.

[Mike Pieciak (Vermont State Treasurer)]: Yeah, of course. Yeah. Good afternoon, everybody. Thanks for having me. Mike Pichak, Vermont state treasurer. Just really want to just hit on a couple of high points. And first is just a point of thanks for the committee for working so hard and spending so much time on this bill and also to the committee and the stakeholders for making the bill better. Also, I think it came in as a good idea with some things that were going to be complicated or some things that consumers are going to have to navigate. Now you've made it so that those things are eliminated and they'll get the benefit of not just the discount card, but the benefit of it counting toward their deductible if they're using it in that fashion. And I think that's a great enhancement and improvement. Appreciate the committee. Appreciate Jen for working on that language with all those stakeholders. I know it was very technical and very detailed and something that had changed a long time ago. When those things happen, sometimes it can be challenging to find a consensus of what the task was and how to move forward. So we provided also just a short overview of the bill and some highlights and impact that it would have here in Vermont and to each of your districts in a generic way. But just to emphasize that even in Vermont, if we hit the same number of consumers that are in Connecticut taking advantage of the discount coverage, about 1% of their population, I think we have reasons to suggest will be higher than that. But even at 1%, the annual discounted savings would be about $18,000,000 across the board for Vermonters. Really significant savings that would go toward anything that those Vermonters want to spend their money on, but I'm presuming it's gonna end up being household expenses given the state of our economy rather than going to pharmaceutical companies. So really appreciate that, and I hope we get that number much higher than 1%. We'll do our best to do that. But also having that appropriation in the bill of 50,000, I think will help us get off and running in a way that Connecticut did not have that opportunity and that advantage. So, wanted to highlight that. And again, you know, the impact I think will be significant without a big price tag operationally. This is not a burden for our office. We're looking forward to getting it up and running and doing the outreach and getting it successful if the committee sees fit to pass it in the House and the Senate.

[Rep. Alyssa Black (Chair)]: Any questions?

[Unidentified Committee Member]: No. You didn't believe that, didn't you? No, I guess I just, when this passes, alright, you get your thousand dollars. Can

[Unidentified Committee Member]: you give me the steps before everybody has the card?

[Mike Pieciak (Vermont State Treasurer)]: Yeah. For sure. So first of all, we'd wanna enter into the relationship with ArrayRx, not about the discount card, but actually the collaboration. And we've had conversations about how fast that would be. And from their end, it'll be very quick. From our end, obviously, we have to go through the contracting process, which sometimes can be very quick, sometimes can be a couple of months. But once we're officially in the program and we know when Vermonters can go on their phone and and mail in and get their card and download their card, then we'll have a plan to announce it, to have earned media alongside of that, meaning we'll have partnerships. We'll do local outreach throughout Vermont and also the earned media of whether it be a TV or Facebook, a digital ad, or other ads to get the word out as well. So really a push. And if everything comes together, you know, and we're able to get that contracting process done in an efficient way, hope the would be that you do it before the end of the year, well before the holidays. So you can sort of capture people's attention and get people signed up before the end of the year.

[Rep. Alyssa Black (Chair)]: I live on a border town. We get prescriptions in New Hampshire. How's that going to work?

[Mike Pieciak (Vermont State Treasurer)]: Yeah, that's a great question. I grew up in Brattleboro. So, I mean, we are always dealing with these issues. And I think there's two benefits. I mean, folks that are in New Hampshire or in Massachusetts or in New York that are coming into Vermont, If they have a Vermont connection and they have that Vermont address, they work for an employer in Vermont, that's open to them as a possibility to download the card and use it and benefit our retail pharmacies and benefit our pharmacies overall. If you happen to live in Vermont and get your pharmaceuticals out of the state because you don't have a pharmacy locally, there are a lot of pharmacies because it's a national program and there are national chains that already accept the ArrayRx, even not just in Vermont. So I can't speak to every pharmacy that might be on the New Hampshire border, but with 65,000 plus pharmacies, there's a good chance that they already accept this ArrayRx card. It's just that you can't have the opportunity to download it because we don't have it available to us in Vermont. So I think it can benefit both sides of the border in that sense.

[Rep. Alyssa Black (Chair)]: Great. Any other questions? All right. That, Jen, do we have a new version number? 2.2. What? Oh, you have a question? Sorry, at this 18,000,000 and just wondering how much

[Jenny Harvey (Office of Legislative Counsel)]: we actually spend in Vermont.

[Rep. Alyssa Black (Chair)]: We know that and how that impact and how we grow.

[Mike Pieciak (Vermont State Treasurer)]: I think we can make estimates because

[Rep. Alyssa Black (Chair)]: That might be helpful for forward looking.

[Mike Pieciak (Vermont State Treasurer)]: Yeah, because there are different pools of ways that these get purchased, but we'll have better data once we have the uptake from the cards. We'll have the use of ourselves. It's not data that we would sell or provide, but you get to see who's using what in terms of the generic way and might be able to make better decisions on what drugs should be covered under Medicaid or elsewhere. So I think that'll come with better data, but I think we can make an estimate.

[Rep. Alyssa Black (Chair)]: Yeah. And let's not forget, we just heard from Green Mountain Care Board and there is data in there about how much Vermonters spend on generics, name brand drugs in Vermont. That would be very helpful, I think. Maybe our reporter, whoever our reporter may be, will keep that in mind. I would entertain a motion that we adopt H577 draft 2.2. So moved. I guess we don't need a second.

[Jenny Harvey (Office of Legislative Counsel)]: I'll second.

[Rep. Alyssa Black (Chair)]: We don't need it though. We don't. We always ask for Well, I'll third. Does anyone want a fourth? With the motion on the table, the clerk will commence to call the roll. Okay. Brian Cina. Yes. Wendy Critchlow. Yes.

[Jenny Harvey (Office of Legislative Counsel)]: Allen Penny Demar.

[Unidentified Committee Member]: Yes.

[Rep. Alyssa Black (Chair)]: Leslie Goldman. Yes. Lori Houghton. Yes. Karen Lueders.

[Rep. Karen Lueders]: Yes. Debra Powers. Yes. Valerie

[Jenny Harvey (Office of Legislative Counsel)]: Taylor. Daisy Berbeco. Yes.

[Rep. Alyssa Black (Chair)]: Francis McFaun.

[Mike Pieciak (Vermont State Treasurer)]: Yes.

[Rep. Alyssa Black (Chair)]: Cherry Black. Yes. So +1 000. And I have asked representative Critchlow to report this

[Jenny Harvey (Office of Legislative Counsel)]: bill. We did. And it's just and Oh,

[Rep. Alyssa Black (Chair)]: favorable with the men. We didn't do a strike call, did we? It's draft 2.2 though. Okay, this is a strike call. So this has to make a couple of stops along the way. It's got to go to both appropriations and ways and means, so probably won't be on the floor for a time. Yes, and we'll watch it through those committees. And thank you very much. Thank you everyone. So actually Nice job. We actually don't have testimony until 02:00. So we can