CurrentMVP Health CarePolicy N/A

Vermont Value Drug List for MVP VT Plus (Non-Standard) plans

Defines a list of value prescription drugs offered with most MVP VT Plus (Non-Standard) plans in Vermont, including patient cost-share information and guidance to consult prescribers and plan documents. Affects members enrolled in MVP VT Plus (Non-Standard) plans in Vermont and their prescribers.

Policy Summary

PayerMVP Health Care

PolicyVermont Value Drug List for MVP VT Plus (Non-Standard) plans

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionReview member-specific benefit documents to confirm whether the listed value drug is covered and contact the prescriber to determine if it is appropriate.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30-dayStandard supply

$1 or $3Co-pay

Most MVP VT PlusPlans

VermontState

Value Drug Coverage Criteria

Value drug coverage conditions

Covered when ALL of the following are met

Plan and enrollment: Member is enrolled in an MVP VT Plus (Non-Standard) plan that offers the Vermont Value Drug list as indicated in their benefit documents.

Review member-specific benefit documents to confirm availability; not all plans offer these drugs.

Prescription supply and cost-share: Medication is dispensed as a 30-day supply and is listed as a value drug available at a $1 or $3 co-pay depending on the VT Plus plan.30-day; $1 or $3

Co-pay and availability vary by the specific MVP VT Plus plan.

Prescriber determination: Prescriber determines that a listed value drug is appropriate to treat the member's medical condition.

Policy Summary

PayerMVP Health Care

PolicyVermont Value Drug List for MVP VT Plus (Non-Standard) plans

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionReview member-specific benefit documents to confirm whether the listed value drug is covered and contact the prescriber to determine if it is appropriate.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Actions for Prescribers and Plan Administrators

Prior Authorization

Check plan documents for authorization requirements

Check the member's specific plan documents and benefit materials to confirm whether prior authorization or other utilization management requirements apply before prescribing or dispensing any medication on the Vermont Value Drug list. Authorization requirements and benefit determinations are governed by the member's plan documents.

Prior authorization and benefit limits are determined by the member's plan documents.
If enrolled in an MVP VT Plus (Non-Standard) plan, the listed value drugs may be available at a $1 or $3 copay for a 30-day supply — verify the member's specific plan.
Members and prescribers should review specific benefit documents and consult MVP Customer Service for confirmation.

Denial Risk

Coverage denial risk reminder

This information does not guarantee coverage. The member's plan documents define benefits, limitations, and exclusions which could result in coverage denial even for drugs listed on the Vermont Value Drug list.

Not a guarantee of coverage — plan documents govern final benefit decisions.
The Vermont Value Drug list may change based on Pharmacy & Therapeutics Committee decisions; verify current status before making therapeutic changes.

Documentation Required

Suggested therapeutic substitutions (for prescriber consideration)

Suggested therapeutic substitutions are provided for prescriber consideration only. Only the prescriber can determine the best treatment for the patient; use these suggestions to discuss potential lower-cost alternatives with the member.

Examples of suggested therapeutic substitutions include matching antihypertensives to diabetes or clot-prevention treatments (e.g., Atenolol → Glipizide for diabetes; Atenolol → Clopidogrel for clot prevention).
These are suggested matches only — clinical judgment and individual patient factors must guide therapy selection.

Note

Provider reminder — verify benefits and consult MVP

Provider reminder: Members and prescribers should review specific benefit documents and consult MVP Customer Service for plan-specific questions or to confirm current formulary status and copay information.

Verify whether the member's employer plan participates in the Vermont Value Drug list offering.
If the plan participates, contact the prescriber to discuss whether a listed value drug is appropriate for the member.

Therapeutic Substitutions and Step Guidance

Source drug (listed)	Therapeutic intent	Suggested substitution / match
{"text":"Atenolol","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Glipizide","status":""}
{"text":"Atenolol","status":""},{"text":"To Prevent Clotting","status":""},{"text":"Clopidogrel","status":""}
{"text":"Clonidine Tab","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Glipizide ER","status":""}
{"text":"Clonidine Tab","status":""},{"text":"To Prevent Clotting","status":""},{"text":"Jantoven","status":""}
{"text":"Enalapril","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Glipizide XL","status":""}
{"text":"Enalapril","status":""},{"text":"To Prevent Clotting","status":""},{"text":"Warfarin Sodium","status":""}
{"text":"Enalapril/HCTZ","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Glipizide-Metformin","status":""}
{"text":"Enalapril/HCTZ","status":""},{"text":"To Prevent Clotting","status":""},{"text":"To Treat Osteoporosis","status":""}
{"text":"Furosemide","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Glyburide","status":""}
{"text":"Furosemide","status":""},{"text":"To Prevent Clotting","status":""},{"text":"To Treat Osteoporosis","status":""}
{"text":"Hydrochlorothiazide Cap","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Glyburide-Metformin","status":""}
{"text":"Hydrochlorothiazide Cap","status":""},{"text":"To Prevent Clotting","status":""},{"text":"Alendronate","status":""}
{"text":"Hydrochlorothiazide Tab","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Metformin","status":""}
{"text":"Hydrochlorothiazide Tab","status":""},{"text":"To Prevent Clotting","status":""},{"text":"To Treat Asthma","status":""}
{"text":"Lisinopril","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Metformin ER (generic Glucophage XR)","status":""}
{"text":"Lisinopril","status":""},{"text":"To Prevent Clotting","status":""},{"text":"To Treat Asthma","status":""}
{"text":"Lisinopril/HCTZ","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Novolin 70-30","status":""}
{"text":"Lisinopril/HCTZ","status":""},{"text":"To Prevent Clotting","status":""},{"text":"Montelukast","status":""}
{"text":"Losartan","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Novolin N","status":""}
{"text":"Losartan","status":""},{"text":"To Prevent Clotting","status":""},{"text":"QVAR","status":""}
{"text":"Losartan/HCTZ","status":""},{"text":"To Treat Diabetes","status":""},{"text":"To Control High Cholesterol","status":""}
{"text":"Losartan/HCTZ","status":""},{"text":"To Prevent Clotting","status":""},{"text":"QVAR","status":""}
{"text":"Losartan/HCTZ","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Fenofibrate Tab (48 mg, 145 mg, 160 mg, 54 mg)","status":""}
{"text":"Losartan/HCTZ","status":""},{"text":"To Prevent Clotting","status":""},{"text":"","status":""}
{"text":"Metoprolol Tartrate","status":""},{"text":"To Treat Diabetes","status":""},{"text":"","status":""}
{"text":"Metoprolol Tartrate","status":""},{"text":"To Prevent Clotting","status":""},{"text":"","status":""}
{"text":"Spironolactone","status":""},{"text":"To Treat Diabetes","status":""},{"text":"Fenofibrate Capsules","status":""}
{"text":"Spironolactone","status":""},{"text":"To Prevent Clotting","status":""},{"text":"","status":""}

Background and Scope

This document presents the Vermont Value Drug list, a collection of medications offered as lower-cost options for members enrolled in most MVP VT Plus (Non-Standard) plans. When a medication is included on the list it is typically available at a $1 or $3 co-pay for a 30-day supply, subject to the member’s specific VT Plus plan design.

The list pairs medications with therapeutic intents (for example, entries labeled “To Treat Diabetes” or “To Prevent Clotting”) and includes suggested substitutions or matchings to help prescribers and members consider lower-cost alternatives. These pairings are informational; only the treating clinician can determine appropriate therapy, and inclusion on the list does not create a clinical mandate.

The Vermont Value Drug list may change as a result of decisions by the MVP Pharmacy and Therapeutics Committee. Members and prescribers should review individual benefit documents and contact MVP Customer Care (1-800-348-8515; TTY 1-800-662-1220) with questions about availability or plan-specific terms.

OpenPayer

Vermont Value Drug List for MVP VT Plus (Non-Standard) plans

Value Drug Coverage Criteria

Actions for Prescribers and Plan Administrators

Key Definitions

Therapeutic Substitutions and Step Guidance

Background and Scope