Bill > H0611

This bill makes several changes affecting the Department of Vermont Health Access and related health programs. It amends laws to require health insurers to report on prescription drug cost increases, with the Attorney General identifying the top 15 drugs for further manufacturer justification of price hikes, and clarifies that "health insurer" includes entities with over 5,000 covered lives for major medical insurance, excluding Vermont Medicaid. The bill also modifies provisions related to 340B entities, which are healthcare organizations that can purchase outpatient drugs at a reduced price from manufacturers, by removing a requirement for manufacturers to offer discounts rather than rebates and allowing 340B drug acquisition by contract pharmacies or covered entities unless federal law requires otherwise. Additionally, it adjusts the composition and responsibilities of the Medicaid and Exchange Advisory Committee, allows for nonqualified reflective health benefit plans if federal cost-sharing reduction payments are suspended, modifies the structure and appointment process for the Clinical Utilization Review Board, and updates eligibility criteria for certain programs by adjusting income thresholds and allowing for increased prepaid burial arrangements for Medicaid eligibility. Finally, the bill mandates coverage for HIV prevention drugs and related supportive services without cost-sharing for Medicaid and other state programs, and requires coverage for doula services under Medicaid, with some provisions taking effect upon passage and others on July 1, 2027, pending federal approval.