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    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyVermont Medicaid Manufacturer Fee Update | OpenPay…
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    CurrentVermont Agency of Human Services – Department of Vermont Health AccessPolicy 10.100

    Pharmaceutical Manufacturer Fee

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    This policy governs the assessment, invoicing, dispute, payment, and delinquency reporting requirements for pharmaceutical manufacturers and labelers whose prescription drugs are paid for by the Department of Vermont Health Access. It applies to drugs provided through Medicaid, Dr. Dynasaur, and VPharm.

    Policy Summary
    PayerVermont Agency of Human Services – Department of Vermont Health Access
    PolicyPharmaceutical Manufacturer Fee
    Policy CodePolicy 10.100
    Change TypeNo material change
    Effective DateNot specified
    Next Review DateNot specified
    Key ActionManufacturers or labelers must remit the annual invoiced fee according to Department of Vermont Health Access instructions.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    1.5%Fee applied to prior calendar year's prescription drug spending
    30 daysTime to notify the Department of a billing error
    30 daysPayment deadline from written invoice date, unless review is pending

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    3 programsApplicable public health programs
    AnnualInvoice and delinquent list updates

    Applicability and Fee Assessment

    Applicability and fee assessment

    The fee applies when all of the following conditions are met:

    ALL of the following

    • ALL of the following

      • Prescription drugs are paid for by the Department of Vermont Health Access
      • The individual participates in Medicaid, Dr. Dynasaur, or VPharm
    • The applicable pharmaceutical manufacturer or labeler is assessed a fee based on manufacturer labeler codes1.5% of the previous calendar year's prescription drug spending by the Department of Vermont Health Access

    Fee Calculation and Billing Parameters

    Manufacturer labeler codes used to assess the feeNDC
    No codes listed
    Pharmaceutical Manufacturer Fee Rate
    Fee rate1.5 percent
    Calculation basisThe previous calendar year's prescription drug spending by the Department of Vermont Health Access
    Assessment methodAssessed based on manufacturer labeler codes
    Billing Error Notification Period
    Notification deadlineWithin 30 days of receipt of the bill
    Notification methodWritten notification to the Department of Vermont Health Access
    Required supportWritten materials setting forth the basis for the requested review

    Manufacturer and Labeler Responsibilities

    Billing Rule

    Fee Responsibility

    Each pharmaceutical manufacturer or labeler is responsible for the fee on prescription drugs paid for by the Department of Vermont Health Access for individuals participating in Medicaid, Dr. Dynasaur, or VPharm.

    Billing Rule

    Annual Fee Payment

    The manufacturer or labeler must remit the annual invoiced fee according to instructions provided by the Department of Vermont Health Access.

    Documentation Required

    Billing Error Review Request

    Key Terms

    Timely Payment
    DefinitionPayment received by the Department of Vermont Health Access within 30 days or less of the date the written invoice was provided
    Alternative timingPayment received upon resolution of the billing review process
    Applies toPayment of the invoiced pharmaceutical manufacturer fee
    Manufacturer or Labeler
    DefinitionThe manufacturer or labeler identified as responsible for prescription drug spending
    Identification methodThrough manufacturer labeler codes
    Relevant spending
    Policy Summary
    PayerVermont Agency of Human Services – Department of Vermont Health Access
    PolicyPharmaceutical Manufacturer Fee
    Policy CodePolicy 10.100
    Change TypeNo material change
    Effective DateNot specified
    Next Review DateNot specified
    Key ActionManufacturers or labelers must remit the annual invoiced fee according to Department of Vermont Health Access instructions.
    SourceLink
    On This Page
    Applicability and Fee AssessmentFee Calculation and Billing ParametersManufacturer and Labeler ResponsibilitiesKey Terms
    Timely Payment Period
    Payment deadlineWithin 30 days or less of the date the written invoice was provided
    Review exceptionPayment may be made upon resolution of the billing review process
    Payment recipientDepartment of Vermont Health Access
    Delinquent List Update Frequency
    Update frequencyAt least annually
    Published byDepartment of Vermont Health Access
    List contentsManufacturers or labelers that have failed to provide timely payment
    Publication locationThe Department's website

    If the manufacturer or labeler believes a billing error has occurred, it must notify the Department of Vermont Health Access in writing within 30 days after receiving the bill. The notice must include written materials setting forth the basis for the requested review.

    Billing Rule

    Timely Payment

    Payment must be received by the Department of Vermont Health Access within 30 days or less of the date the written invoice was provided, or upon resolution of the billing-error review process.

    Denial Risk

    Delinquency Reporting

    The Department of Vermont Health Access maintains a website list of manufacturers or labelers that fail to provide timely payment and updates the list at least annually.

    Prescription drug spending paid for by the Department of Vermont Health Access