Vt. Stat. Ann. tit. 18, § 9471
Repealed. 2023, No. 127 (Adj. Sess.), § 4(a)(2), eff. July 1, 2029
Redline — July 1, 2021 → current.View current text →
Current — June 1, 2022
As of July 1, 2021
As used in this subchapter:
As used in this subchapter:
(1) "Beneficiary" means an individual enrolled in a health plan in which coverage of prescription drugs is administered by a pharmacy benefit manager and includes his or her dependent or other person provided health coverage through that health plan.
(1) “Beneficiary” means an individual enrolled in a health plan in which coverage of prescription drugs is administered by a pharmacy benefit manager and includes his or her dependent or other person provided health coverage through that health plan.
(2) "Health insurer" is defined by section 9402 of this title and shall include: a health insurance company, a nonprofit hospital and medical service corporation, and health maintenance organizations;
(2) “Health insurer” is defined by section 9402 of this title and shall include: a health insurance company, a nonprofit hospital and medical service corporation, and health maintenance organizations;
(3) an employer, labor union, or other group of persons organized in Vermont that provides a health plan to beneficiaries who are employed or reside in Vermont;
(3) an employer, labor union, or other group of persons organized in Vermont that provides a health plan to beneficiaries who are employed or reside in Vermont;
(4) the State of Vermont and any agent or instrumentality of the State that offers, administers, or provides financial support to State government; and
(4) the State of Vermont and any agent or instrumentality of the State that offers, administers, or provides financial support to State government; and
(5) Medicaid, and any other public health care assistance program.
(5) Medicaid, and any other public health care assistance program.
(6) "Health plan" means a health benefit plan offered, administered, or issued by a health insurer doing business in Vermont.
(6) “Health plan” means a health benefit plan offered, administered, or issued by a health insurer doing business in Vermont.
(7) "Pharmacy benefit management" means an arrangement for the procurement of prescription drugs at a negotiated rate for dispensation within this State to beneficiaries, the administration or management of prescription drug benefits provided by a health plan for the benefit of beneficiaries, or any of the following services provided with regard to the administration of pharmacy benefits: mail service pharmacy;
(7) “Pharmacy benefit management” means an arrangement for the procurement of prescription drugs at a negotiated rate for dispensation within this State to beneficiaries, the administration or management of prescription drug benefits provided by a health plan for the benefit of beneficiaries, or any of the following services provided with regard to the administration of pharmacy benefits: mail service pharmacy;
(8) claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries;
(8) claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries;
(9) clinical formulary development and management services;
(9) clinical formulary development and management services;
(10) rebate contracting and administration;
(10) rebate contracting and administration;
(11) certain patient compliance, therapeutic intervention, and generic substitution programs; and
(11) certain patient compliance, therapeutic intervention, and generic substitution programs; and
(12) disease or chronic care management programs.
(12) disease or chronic care management programs.
(13) "Pharmacy benefit manager" means an entity that performs pharmacy benefit management. The term includes a person or entity in a contractual or employment relationship with an entity performing pharmacy benefit management for a health plan.
(13) “Pharmacy benefit manager” means an entity that performs pharmacy benefit management. The term includes a person or entity in a contractual or employment relationship with an entity performing pharmacy benefit management for a health plan.
(14) “Maximum allowable cost” means the per unit drug product reimbursement amount, excluding dispensing fees, for a group of equivalent multisource generic prescription drugs. Added 2007, No. 80, § 8; amended 2013, No. 79, § 21, eff. Jan. 1, 2014; 2015, No. 54, § 2, eff. June 5, 2015.
(14) “Maximum allowable cost” means the per unit drug product reimbursement amount, excluding dispensing fees, for a group of equivalent multisource generic prescription drugs.
Official source: Vermont General Assembly. Reproduced from public-domain Vermont statutes; confirm against the official source for the current text. Not legal advice.