Drug companies and state Medicaid programs could enter "value-based purchasing arrangements" — essentially pay-for-performance deals where the price of an expensive medication depends on how well it actually works for patients. Right now, the way Medicaid calculates drug prices makes these deals complicated and sometimes financially impractical. This bill would fix that by letting manufacturers report multiple "best price" points for the same drug depending on patient outcomes, and by excluding refunds tied to treatment failures from average price calculations. It also provides an exception from anti-kickback rules for these arrangements and requires a GAO study on whether the deals are improving access and lowering costs.
Corporate Benefits
- Best-price reporting flexibility — Manufacturers may report multiple best-price points for a single drug under value-based purchasing arrangements
- Anti-kickback Statute safe harbor — Manufacturer payments to states tied to outcome failures excluded from §1128B(b) prohibitions
- Outcome-failure remuneration in Average Manufacturer Price — Excluded from AMP and Average Sales Price calculations under VBP arrangements
Transparency & Accountability
- GAO study and report — Comptroller General must study patient access, outcome impact, and Medicaid-cost effects of VBP arrangements by June 2029
- HHS guidance on VBP for inpatient drugs — Secretary required to issue guidance to state Medicaid agencies within 180 days
Congressional Summary
Medicaid VBPs for Patients Act or the MVP ActThis bill provides statutory authority for regulations that allow for the use of varying best price points under value-based purchasing arrangements for purposes of the Medicaid Drug Rebate Program. (Value-based purchasing arrangements refer to arrangements in which the price of a drug is linked to clinical outcomes; such arrangements are particularly used for new high-cost treatments, such as gene therapies.)The Government Accountability Office must study the impact of value-based purchasing arrangements on federal health care programs, including with respect to the bill's changes.Additionally, the bill (1) exempts sales of drugs that are made under value-based purchasing arrangements from calculations of the manufacturer average sales price for purposes of payments under Medicare medical services, if the manufacturer reports multiple best prices under Medicaid in accordance with the bill's changes; and (2) requires the Centers for Medicare & Medicaid Services to issue guidance on how state Medicaid programs may cover drugs in inpatient settings via value-based purchasing arrangements.
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2026-03-09
- Date Added
- 2026-03-30
- Source
- Congress.gov →
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