Allows states and drug manufacturers to use value‑based purchasing deals for outpatient drugs while letting manufacturers report multiple Medicaid “best price” points and adjusting Medicare pricing rules to match; creates a narrow exception to the federal anti‑kickback law for certain manufacturer payments to states tied to outcomes; requires HHS rulemaking and guidance within 180 days and orders a GAO study with a report due June 30, 2029. The changes aim to enable outcome‑based payments across multiple states, align how drug prices and rebates are calculated under Medicaid and Medicare, and assess effects on access, costs, and health outcomes.