Sponsors (11)
The bill creates clearer, time‑bound pathways for state Medicaid value‑based purchasing that could lower drug costs and improve access for many patients, but it also risks higher list prices, greater administrative burdens, potential access tradeoffs for vulnerable patients, and higher Medicare/federal spending depending on how manufacturers and markets respond.
State Medicaid programs and Medicaid beneficiaries can use value-based purchasing arrangements (outpatient and inpatient) and manufacturer performance payments to lower net drug costs for state budgets, taxpayers, and patients.
States, manufacturers, and federal agencies gain regulatory clarity and predictable timelines (HHS/OIG rulemaking within 180 days and required GAO study) to design and implement value-based purchasing, reducing uncertainty that slows adoption.
Medicare Part B beneficiaries and providers may see slower Part B drug spending growth and simpler pricing if certain manufacturer discounts tied to value‑based arrangements are excluded from ASP calculations and aligned with AMP exclusions.
Patients (commercial and Medicare), taxpayers, and beneficiaries risk higher list prices or shifting of costs if manufacturers adjust pricing or best‑price reporting to offset rebate or reimbursement effects, raising baseline prices in commercial and federal programs.
States, manufacturers, and providers face increased administrative complexity, compliance costs, and negotiation burdens from new rules, multiple best-price handling, installment-payment treatment, and inter‑state payment arrangements, which could slow implementation and raise operating costs.
Medicare program spending and provider acquisition costs could increase if excluding certain discounts from ASP leads to higher Medicare reimbursements, putting pressure on taxpayers and hospitals/physician practices.
Based on analysis of 6 sections of legislative text.
Enables multi‑point best‑price reporting and legal pathways for State value‑based drug purchasing, aligns AMP/ASP rules, adds an anti‑kickback safe harbor, and requires HHS/OIG rulemaking and a GAO study.
Introduced March 9, 2026 by Brett Guthrie · Last progress March 9, 2026
Allows State Medicaid programs to enter value-based purchasing arrangements (VBPAs) for outpatient drugs and aligns federal drug-pricing rules so manufacturers can report multiple "best price" points when drugs are sold under those arrangements. The bill changes how manufacturer prices count toward Medicaid rebate calculations and Medicare Part B average sales price, creates a new safe-harbor under the federal anti‑kickback statute for outcome‑based payments from manufacturers to States, requires HHS guidance and rulemaking within 180 days on implementation details, and orders a GAO study on the effects of VBPAs with a report due by June 30, 2029. The changes aim to make value-based contracting between States and drug manufacturers easier while adjusting AMP/ASP reporting rules and providing legal protection for certain manufacturer payments tied to patient outcomes; it also directs federal agencies to issue implementing rules and guidance on a tight timeline and to study program impacts.