NO. 2. AN ACT RELATING TO THE I-SaveRx PRESCRIPTION DRUG PROGRAM.
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. LEGISLATIVE FINDINGS
The general assembly makes the following findings of fact:
(1) I-SaveRx is a prescription drug program implemented by Illinois in October 2004.
(2) I‑SaveRx allows all Illinois residents to refill prescriptions for the most common brand-name prescription drugs used to treat chronic illnesses from a network of inspected and approved pharmacies in Canada, and the United Kingdom. The mail order pharmacy program is accessible through a web site and a 24-hour toll-free telephone number.
(3) Participants in I‑SaveRx are expected to save from 25 to 50 percent on the cost of medications. The program includes provisions to ensure the safety and quality of the prescriptions by requiring the inspection and approval of the pharmacies who participate.
(4) Since implementation of I‑SaveRx, Wisconsin, Missouri, and Kansas have joined the program.
(5) Vermont residents require timely access to safe, high quality, and efficacious prescription drugs that are not available in the United States at affordable prices.
(6) Illinois has expended significant time and resources in inspecting and ensuring the safety of pharmacies in Canada and Europe. It has contracted with a pharmacy benefit manager (“PBM”) for services, including the provision of certain prescription drugs from Canada, Ireland, and the United Kingdom, in a safe and affordable manner to participating citizens.
(7) Reimportation is not a comprehensive, long-term solution to the problem of drug affordability; however, I‑SaveRx will provide Vermonters with an interim option for obtaining safe and affordable prescription drugs.
Sec. 2. PRESCRIPTION DRUG REIMPORTATION PROGRAM
(a) Illinois I‑SaveRx program. The state of Vermont hereby enters into an agreement with the state of Illinois regarding access for each state’s residents to safe and affordable prescription drugs from Canada, Ireland, and the United Kingdom through the state of Illinois I‑SaveRx program.
(b) Program Operation.
(1) Web Site. Vermont will maintain a separate web site that provides a link to www.I‑SaveRx.net. In its pharmacy benefits management agreement with its PBM, Illinois shall specify that citizens with Vermont zip code addresses shall be provided access to the services available through the I‑SaveRx program, and that Vermont residents shall be considered “Program Participants,” as that term is defined in the PBM agreement. The operation and administration of the web site accessed via the I‑SaveRx site will be the responsibility of the PBM, as is outlined in the PBM agreement.
(2) Drug Supply/Capacity. Vermont will work with other participating states to ensure adequate supply of prescription drugs from the program countries. In the event that demand exceeds the supplies available, Illinois shall have first priority over all other program participants. “Participating states” shall mean Illinois and any other state that enters or has entered into an agreement with the state of Illinois to participate in the I‑SaveRx program.
(c) Vermont Independent Oversight.
(1) Standards of Practice.
(A) The Joint Work Group. To ensure adequate Vermont input regarding the safe and effective administration of the I-SaveRx program, Vermont shall be part of the Joint Work Group (the “JWG”), composed of two representatives from each participating state. The JWG shall meet or confer on an as-needed basis. The Vermont representatives shall be the commissioner of health and the chair of the board of pharmacy or their designees.
(B) Compliance. Illinois will act as the primary administrator of the PBM agreement. To ensure the safety of their respective residents, the participating states have agreed upon a single set of standards of practice, outlined in schedule A of the PBM agreement. These standards of practice are incorporated into the PBM agreement between Illinois and the PBM. Under the PBM agreement, the PBM and the pharmacies participating in the network set up by the PBM (the “network pharmacies”) are obligated to comply with the agreed-upon standards of practice. The term “network pharmacies” shall have the same meaning that it does under the PBM agreement.
(C) Monitoring. Any reports issued by the PBM or local regulatory authorities regarding the network pharmacies’ compliance, or lack thereof, with the standards of practice shall be provided to Vermont. The JWG shall determine the specific types of data that should be included in any such reports issued by the PBM and the periodic basis on which such reports will be issued.
(D) Modification. In the event that Illinois or the PBM wishes to modify the agreed-upon standards of practice, Illinois will notify Vermont in writing at least 15 days prior to the planned implementation of such amendment or modification. The standards of practice may not under any circumstances be modified or amended without the full and unanimous consent of the JWG. Additionally, the JWG will review the standards of practice periodically for the purpose of considering modifications or amendments.
(E) Violation. In the event that the standards of practice are violated by one of the network pharmacies, Vermont shall provide written notice to Illinois and the PBM of such violation. Upon receiving such written notice from Vermont, Illinois shall instruct the PBM to suspend immediately such pharmacy from the list of network pharmacies eligible to fill prescriptions for program participants, pending further review by the PBM and the participating states, which may result in either reinstatement or exclusion from participation in the program.
(F) Additional participating states. In the event that other states, in addition to Vermont, join Illinois in providing access to prescription drugs through the I‑SaveRx program, Illinois shall provide written notice to Vermont. Further, Illinois shall ensure that such addition of other states will not in any way render less stringent the existing standards of practice.
(2) Inspections. Under the PBM agreement, Illinois may conduct on-site inspections of the network pharmacies with or without advance notice. Vermont also may participate in such inspections along with Illinois. To the extent that additional pharmacies are added to the list of network pharmacies, Vermont independently may inspect those pharmacies as well. Vermont will provide in writing to Illinois any plans or intentions of Vermont to inspect independently 14 days prior to such inspection, unless the inspection is an investigation of a complaint.
(3) Drug List. Under the PBM agreement, only those prescription drugs approved by Illinois will be filled by the network pharmacies for the I‑SaveRx program participants. The JWG shall review the approved drug list periodically and consider any proposed changes. The approved drug list may not be modified without the consent of the JWG. Only in the event that the JWG cannot agree on a proposed modification to the drug list shall the voting power of the JWG be determined by the respective populations of the participating states.
(d) Marketing, media relations, and outreach. Vermont and Illinois will coordinate, where mutually beneficial, media and outreach efforts. Additionally, with input from Illinois, Vermont independently will promote the I‑SaveRx program. Vermont will use the name, logo, web site, and marketing materials that have been developed by Illinois; however, the Vermont state seal and the governor’s name may be added to the materials. Vermont understands that the PBM will pay I-SaveRx acquisition fees to the program to be used for such activities as marketing, outreach, and additional inspections. Vermont shall be entitled to such pool of acquisition fees in an amount proportional to the percentage of I‑SaveRx prescription drug sales attributable to Vermont zip codes.
(e) Cancellation. Vermont or Illinois may withdraw from this agreement and terminate this cooperative relationship at any time, with or without cause, upon written notice to the other states. Withdrawal by Vermont may be accomplished by act of the general assembly amending or repealing this act, or by the governor, with the approval of the joint fiscal committee.
(f) Liability. Neither the state of Vermont nor its agencies, employees, agents, or representatives taking any act as a result of this agreement will have any liability for the acts or omissions of the state of Illinois or its agencies, employees, agents, or representatives in carrying out the activities governed by this agreement. Neither the state of Illinois nor its agencies, employees, agents, or representatives taking any act as a result of this agreement will have any liability for the acts or omissions of the state of Vermont or its agencies, employees, agents, or representatives in carrying out the activities governed by this agreement.
Sec. 3. IMPLEMENTATION; PUBLICITY AND OUTREACH
(a) The secretary of human services shall be responsible for implementing this act.
(b) Within 21 days of passage of this act, the secretary of human services shall convene a working group to develop outreach and promotion tools related to the I‑SaveRx program.
(c) Members of the working group shall include the commissioner of health, the director of the office of Vermont health access, the commissioner of the department for children and family services, the commissioner of aging and independent living, the commissioner of human resources, the health care ombudsman and the long‑term care ombudsman, or their respective designees; and at least one representative from each of the following organizations: the area agencies on aging, the community action agencies, the Vermont coalition for disability rights, the Vermont medical society, the Vermont low income advocacy council, the community of Vermont elders, BiState primary care, the coalition of uninsured clinics, and AARP Vermont; as well as interested consumers, advocates, and providers appointed by the secretary of human services.
(d) Activities of the working group shall include developing communication tools such as enrollment forms, explanatory brochures, a web site, inserts in utility and tax bills, and promotional magnets and posters; and directing outreach and material distribution to all health care providers and relevant health care associations.
Sec. 4. LIABILITY; STATE OF VERMONT
The state of Vermont shall not be liable for any injury or damage caused to a person from products obtained through the I‑SaveRx program.
Sec. 5. 8 V.S.A. § 4089i is amended to read:
§ 4089i. PRESCRIPTION DRUG COVERAGE
A health insurance or other health benefit plan offered by a health insurer shall provide coverage for prescription drugs purchased in Canada, and used in Canada or reimported legally, or purchased through the I‑SaveRx program, on the same benefit terms and conditions as prescription drugs purchased in this country. For drugs purchased by mail or through the internet, the plan may require accreditation by the Internet and Mailorder Pharmacy Accreditation Commission (IMPAC/tm) or similar organization.
Sec. 6. EFFECTIVE DATE
(a) This act shall take effect from passage.
(b) The I‑SaveRx program as provided and agreed to in Sec. 2 of this act shall be implemented in Vermont on or before May 1, 2005.
Approved: February 17, 2005
The Vermont General Assembly
115 State Street