YesOn766

YesOn766

If you are one of the many Vermonters with a health condition yourself or supporting a family member who needs to use their insurance benefits, Act 111 may help you access health care!

H. 766 (Act 111) Prior Authorization Reform Law Takes Effect on 1/1/25

What Act 111 does:

  • Requires health plans to respond to urgent prior authorization requests within 24 hours – meaning less time waiting for an answer about live-saving medical services;
  • If you are on ongoing, chronic medications, you will get to continue on your medication or treatment for five years without going through prior authorization again – instead of every year – saving you and your doctor time and stress each year;
  • If you are stable on a medication, you or your provider can request to stay on it rather than going back through “step therapy” or “fail first” policies, which require a patient to try and fail one or more medications before they can access the medication actually recommended and prescribed by their healthcare provider;
    • Read a fact sheet about these important “step therapy” reforms here.
  • Allows you to access at least one readily available asthma controller medication without prior authorization– addressing a crisis in pediatrics right now where kids can’t obtain medication to help them breath and are ending up in the ED;
  • Allows your primary care provider to order your tests, imaging and procedures with no prior authorization;
      • Primary care clinicians/practices – see available resources from the American College of Radiology to assist with clinical decision making regarding imaging in the absence of PA
  • If you switch to a new health plan, they will have to let you continue on a stable medication or treatment for at least 90 days.

** Note that these changes will only apply to private health plans regulated by the State, not Medicaid, Medicare or large group health plans.

  • Read the text of the law here.
  • Find a summary of the law here.
  • Read the Governor's letter when he signed the bill here.
  • Read the VMS press statement on the Governor signing the bill here.