Medicaid VBPs for Patients Act

What it does

This 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 establish a program under which state Medicaid programs may cover drugs in inpatient settings via value-based purchasing arrangements.

The bill's changes terminate five years after enactment; any value-based purchasing arrangements that are in effect as of the date of termination continue to apply.

Summary by the Congressional Research Service, Apr 18, 2023 (Introduced in House). CRS summarizes bills impartially; it does not take positions.