Sponsors (17)
The bill creates a clearer, faster pathway for states and manufacturers to use value-based purchasing—potentially lowering Medicaid drug spending and improving patient outcomes—while risking higher list prices, reduced rebates and Medicare costs, added administrative burdens, and possible access harms for some patients.
State Medicaid programs (and taxpayers) can lower net drug spending because the bill enables and clarifies value-based purchasing (outpatient and inpatient) and allows manufacturer payments tied to drug performance.
Manufacturers, states, and providers gain clearer rules and faster timelines to implement value-based arrangements because the bill includes statutory definitions and requires HHS/OIG rulemaking within 180 days.
Medicaid patients may get better access and continuity of care and potentially better clinical outcomes because the bill permits interstate treatment billing as if care occurred in the home state and encourages outcome-driven arrangements.
Manufacturers could respond by raising list prices or shifting discounts into complex arrangements, which would raise baseline commercial prices and increase costs for patients and taxpayers.
Value-based exclusions from ASP and other pricing changes could increase Medicare reimbursements and program spending, raising taxpayer costs and potentially increasing provider acquisition costs.
Medicaid beneficiaries risk higher net prices or reduced manufacturer rebates if manufacturers change pricing/best-price reporting to preserve commercial or Medicare revenues.
Based on analysis of 6 sections of legislative text.
Permits multi‑point best‑price reporting for drugs sold under Medicaid value‑based purchasing, aligns Medicare pricing rules, adds an antikickback safe harbor, directs HHS/OIG rulemaking and a GAO study.
Official title: To amend title XIX of the Social Security Act to codify value-based purchasing arrangements under the Medicaid program and reforms related to price reporting under such arrangements, and for other purposes.
Introduced March 9, 2026 by Brett Guthrie · Last progress March 9, 2026
Allows manufacturers and States to use and report multiple price points for drugs sold under value‑based purchasing (VBP) arrangements in Medicaid, aligns Medicare reimbursement rules with those VBP price treatments, creates a narrow antikickback safe harbor for manufacturer payments to States under VBP agreements, requires HHS rulemaking and guidance within 180 days, and directs a GAO study on how VBP arrangements affect access, costs, and outcomes.