Green Mountain Care Board recommends voluntary cost‑plus and CivicaRx options to curb prescription prices

The Green Mountain Care Board presented the final report required under Act 134, summarizing a year‑long analysis and proposing five practical, voluntary options to reduce prescription drug costs in Vermont.

Director Catherine O'Neil and analysts said their work combined a national landscape review with data analysis (VCURES) and dashboards. "Because generics make up most prescriptions in Vermont ... it favors cost containment strategies that are voluntary and market-based," the board said, noting that VCURES does not include rebate data and that savings estimates are based on allowed amounts before rebates.

The board recommended Vermont explore two alternative purchasing models for generics: a cost‑plus approach (manufacturer cost plus a 15% margin, applied to a defined list of drugs) and participation in CivicaRx for essential generics, particularly those used in hospitals. Analysts showed a modeled scenario in which roughly 1,811 generics repriced under cost‑plus in 2025 could save an estimated $23.6 million across payers, assuming no change in utilization. They emphasized Medicare would capture a large share of modeled savings and noted limitations in the dataset and methodology.

The board also recommended distributing a new drug discount card (ArrayRx), establishing an advisory committee to develop lists and operational rules, and developing strong price‑transparency tools. Officials cautioned that federal programs — notably CMS's Maximum Fair Price negotiation program — are new and complex; expanding negotiated Medicare prices into state Medicaid or commercial markets would present administrative and legal challenges and is not recommended at this time.

Analysts highlighted that price growth — not volume — has driven spending increases: generics account for about 82% of prescriptions by count while brand drugs account for about 86% of spending, with Humira, Eliquis and semaglutide among top spend drivers. Committee members expressed cautious interest, asked who would lead stakeholder alignment and requested the board provide further detail on implementation steps and potential legislative authority if needed.

The board said the proposed approach emphasizes stakeholder alignment and voluntary participation, with the Green Mountain Care Board positioned to host an advisory process if the legislature directs further action.