VPharm Vermont: Help With Medicare Drug Costs (2026)

VPharm, Vermont's state pharmaceutical assistance program, pays your Medicare Part D premium and Part D cost-sharing for a monthly premium of $15, $20, or $50, set by your income tier. In VPharm's lowest tier, under Vermont's guidelines effective January 1, 2026, monthly income can run up to $1,995 for a household of one and $2,707 for a household of two. VPharm is open to Vermont residents who are 65 or older or living with disabilities, are enrolled in Medicare Part D, and have household income no greater than 225% of the federal poverty level.1

In This Guide

• Key Takeaways
• What VPharm Pays For in Vermont
• Who Qualifies for VPharm in Vermont?
• The Three Premium Tiers and 2026 Income Limits
• What You Still Pay at the Pharmacy Counter
• How VPharm Sits On Top of Medicare Part D
• VPharm or Healthy Vermonters?
• How to Apply for VPharm in Vermont
• Frequently Asked Questions
• Learn More

What VPharm Pays For in Vermont

VPharm is run by DVHA, a department of Vermont's Agency of Human Services, and it's established in state law at 33 V.S.A. § 2073 as a state pharmaceutical assistance program providing supplemental pharmaceutical coverage to Medicare beneficiaries.1

The statute is specific about what the program picks up. Three parts of § 2073(c) do most of the work for a VPharm member:

1. Your Part D premium. The actual Medicare Part D premium for the standard prescription drug benefit offered by Part D plans, except for any late enrollment penalties. DVHA may also pay or subsidize a higher premium for a Part D plan offering expanded benefits, if doing so is cost-effective.1
2. Other Part D cost-sharing. Any other cost-sharing Medicare Part D requires, with two carve-outs written into the statute: copayments for people who are eligible for Medicaid, and the enrollee's own copay described below.1
3. Certain drugs Part D doesn't cover. If your Part D plan doesn't cover a drug, VPharm reaches the categories of pharmaceuticals that Section 1927(d)(2) or (3) of the Social Security Act allows Medicaid to exclude or restrict.1

Part D plans are allowed to leave out whole classes of drugs, and for a VPharm member the state program is what stands behind those.

Who Qualifies for VPharm in Vermont?

Two tests run at once, and you have to clear both.

The first is the program's own test. DVHA states VPharm eligibility as individuals who meet the income guidelines and are enrolled in Medicare Part D coverage. Vermont's statute adds a condition to that: a VPharm applicant must be participating in Part D and must have secured the Part D low-income subsidy, also called Extra Help, if the applicant is eligible for it.1 Apply for Extra Help first if you haven't.

The second is Vermont's general eligibility statute for its pharmaceutical assistance programs, 33 V.S.A. § 2072, which lists three requirements:1

• You're a resident of Vermont at the time you apply.
• You're at least 65 years old, or you're an individual with disabilities as the statute defines that term.
• Your household income, calculated using modified adjusted gross income, is no greater than 225% of the federal poverty level.1

One more line in § 2072 rules people out. Under that Vermont statute, a person whose pharmaceutical expenses are paid or reimbursable, in whole or in part, by any other plan of assistance or insurance is not eligible for VPharm, with Medicare and Medicaid expressly excepted from that bar.1 In practice, that means other drug coverage sitting alongside Part D is worth raising with DVHA before you apply.

The Three Premium Tiers and 2026 Income Limits

VPharm is banded into three tiers. Which one you land in depends on your household income against the federal poverty level, and the tier sets your monthly premium. DVHA publishes the dollar ranges each year; these are the monthly income ranges effective January 1, 2026.1

Two details are worth holding onto. VPharm's premium is per person per month, so a Vermont household with both spouses enrolled pays for both.1 And the dollar figures move. Vermont's statute sets VPharm's $15.00, $20.00 and $50.00 premiums as base cost-sharing amounts and directs that they be indexed to the increases established under 42 C.F.R. § 423.104(d)(5)(iv) and then rounded to the nearest dollar.1 The income ranges are tied to the federal poverty level, which is updated annually. Read the current year's guidelines from DVHA before you rely on a figure.

Income just above one tier's ceiling moves a member up a tier rather than out of VPharm, until it passes the program's statutory outer limit of 225% of the federal poverty level.1

What You Still Pay at the Pharmacy Counter

Vermont's statute fixes what a VPharm member owes at the register, and the amount is small. A VPharm member contributes $1.00 for a prescription where the cost-sharing amount required by Medicare Part D is less than $30.00, and $2.00 where the Part D cost-sharing amount is $30.00 or more.1

A protection comes with that copay: under the same Vermont statute, a pharmacy may not refuse to dispense a prescription to a VPharm member who does not provide the copayment.1

So the arithmetic for a VPharm 1 member in Vermont is a $15 monthly premium plus $1 or $2 per prescription, with VPharm covering the Part D premium and other Part D cost-sharing above that.1

How VPharm Sits On Top of Medicare Part D

VPharm doesn't replace a drug plan. It wraps around one.1 That order is the federal rule for state pharmaceutical assistance programs generally: 42 CFR 423.464(b) provides that "a Part D plan is always the primary payer relative to a State Pharmaceutical Assistance Program."2 Your Part D plan prices and adjudicates the prescription first; the state program then helps with what's left.

Two federal rules attach to membership in a qualified state pharmaceutical assistance program.

The first is a special enrollment period. Under 42 CFR 423.38(c)(17), someone who belongs to a qualified program "is eligible to make one enrollment election per year" outside the normal fall enrollment window, and that window stays open for an additional two calendar months after the month eligibility is lost or the member is notified, whichever is later.3 One election a year, not an anytime switch, so spend it deliberately.

The second is how the help is counted. Under the federal definition of incurred costs at 42 CFR 423.100, costs paid under a state pharmaceutical assistance program count among your incurred costs when Medicare decides whether you've reached your annual Part D out-of-pocket threshold.4

The federal definition of a qualified state pharmaceutical assistance program, at 42 CFR 423.464(e)(1), excludes "State Medicaid programs, section 1115 demonstration programs, and any other program where program funding is from Federal grants, awards, contracts, entitlement programs, or other Federal sources of funding."2 VPharm's expenditure authority runs through Vermont's Global Commitment to Health section 1115 demonstration, where CMS carries it as Demonstration Population 7 and, for the tiers above 150% of the federal poverty level, Demonstration Population 8.1 None of that changes what VPharm pays a Vermont member.

So ask DVHA or your Medicare Part D plan how they treat your VPharm membership before you count on the once-a-year election or on VPharm's payments counting toward your Part D out-of-pocket threshold. The CMS document that names VPharm as a state pharmaceutical assistance program is the list of programs excluded from Medicaid best price, last updated in August 2023, which exists to serve a Medicaid drug-pricing rule. On that list, VPharm is the only Vermont program CMS names.1

VPharm or Healthy Vermonters?

Vermont runs two prescription programs through DVHA, and they're easy to mix up.

VPharm is the Medicare Part D wraparound this guide covers. A VPharm member pays a monthly premium and must be enrolled in Medicare Part D.1

Healthy Vermonters is a Vermont prescription discount program with no monthly premiums. Healthy Vermonters' eligibility test is income plus having no prescription coverage, or having reached the maximum benefit on your current coverage. CMS does not name Healthy Vermonters on its list of state pharmaceutical assistance programs.1

The practical split: if you're on Medicare Part D, VPharm is the program built for you. If you have no drug coverage at all, Healthy Vermonters is the one to ask DVHA about. Both come off the same 201P Pharmacy Programs Application.1

How to Apply for VPharm in Vermont

There is one form, the 201P Pharmacy Programs Application, and three ways to get it back to the state.1

1. Online. Download and fill out the 201P application, then use DVHA's Document Uploader to submit the signed form and copies of your supporting documents.1
2. By mail. Print and complete the 201P, or call and ask that one be mailed to you, and return it to Green Mountain Care, Application and Document Processing Center, 280 State Drive, Waterbury, VT 05671-1500.1
3. By phone. Call 1-800-250-8427, Monday through Friday, 8am to 4:30pm, to apply by phone.1

Before you file, do two things. Confirm you're enrolled in a Medicare Part D plan, since that's a condition of eligibility. And apply for the federal Part D low-income subsidy if you might be eligible, because the statute expects an applicant to have secured it.1 Vermont's Medicare Savings Programs are worth reading about in the same sitting.

Learn More

Find personalized help sorting out VPharm and your Medicare Part D drug costs in Vermont at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.