2014 Vermont Statutes
Title 18 - Health
Chapter 221 - HEALTH CARE ADMINISTRATION
Subchapter 9: PHARMACY BENEFIT MANAGERS
§ 9473 Pharmacy benefit managers; required practices with respect to pharmacies

§ 9473. Pharmacy benefit managers; required practices with respect to pharmacies

(a) Within 14 calendar days following receipt of a pharmacy claim, a pharmacy benefit manager or other entity paying pharmacy claims shall do one of the following:

(1) Pay or reimburse the claim.

(2) Notify the pharmacy in writing that the claim is contested or denied. The notice shall include specific reasons supporting the contest or denial and a description of any additional information required for the pharmacy benefit manager or other payer to determine liability for the claim.

(b) A pharmacy benefit manager or other entity paying pharmacy claims shall not:

(1) impose a higher co-payment for a prescription drug than the co-payment applicable to the type of drug purchased under the insured's health plan;

(2) impose a higher co-payment for a prescription drug than the maximum allowable cost for the drug; or

(3) require a pharmacy to pass through any portion of the insured's co-payment to the pharmacy benefit manager or other payer. (Added 2013, No. 144 (Adj. Sess.), § 14.)