The bill amends current law to establish limitations on hospital charges for outpatient prescription drugs, specifically addressing reimbursement claims submitted to health insurers. Under the new provisions, hospitals are prohibited from charging more than 120 percent of the average sales price (ASP) for prescription drugs administered in outpatient settings, effective January 1, 2026. Additionally, for the period between July 1, 2025, and December 31, 2025, hospitals may not submit claims exceeding 130 percent of the ASP for drugs for which they previously charged more than 120 percent of the ASP as of April 1, 2025. Hospitals are also required to update the ASP for each drug biannually and cannot increase charges for other services to offset revenue losses due to these limitations.

The bill includes provisions allowing hospitals to propose increases in commercial reimbursement rates if they can demonstrate to the Green Mountain Care Board that the price caps negatively impact access to care or the quality of services. Furthermore, the limitations do not apply to independent critical access hospitals that are not affiliated with other hospital networks. The effective dates for the various sections of the bill are staggered, with the outpatient prescription drug charge limitations taking effect on July 1, 2025, and January 1, 2026, for different provisions, while the remainder of the act will take effect upon passage.

Statutes affected:
As Introduced: 18-3631
As Passed By the House -- Official: 18-3631