MVP Act

This bill lets Medicaid and Medicare use “pay-for-results” deals for some prescription drugs. In these deals, a drug’s price is tied to how well it works for patients. The bill locks in rules so drug makers can offer different prices based on results, as long as the same type of deal is offered to all states. It also tells Medicaid to get official guidance on using these deals for drugs given during a hospital stay, including how states can team up and settle payments when a patient gets treated in another state. The bill also updates Medicare’s pricing rules so certain pay-for-results rebates don’t skew payment formulas. Finally, it orders a federal study to see if these deals improve access, health outcomes, and costs, with results due in 2029 .

Here are the key points:

• What changes: States can use multiple “best prices” for a drug under Medicaid if tied to results and offered to all states; Medicare must ignore certain outcome-based rebates when setting payment rates; HHS must issue guidance for inpatient drug deals; and there’s a safe harbor so a drug maker’s refunds to a state when a patient doesn’t meet set health goals aren’t treated as kickbacks. A government review will measure effects on access, outcomes, and costs .

Small table of who/what/when:

• Who is affected: Medicaid patients (including those needing high-cost drugs like some gene therapies), state Medicaid programs, drug manufacturers, and Medicare providers and payers .
• What changes: Allows and clarifies pay-for-results drug pricing; permits multiple best prices; adjusts Medicare price calculations; gives states guidance for inpatient use; adds an anti-kickback exception for outcome-based refunds; requires a federal study .
• When: HHS must issue Medicaid inpatient guidance and other rules within 180 days of enactment; the federal study report is due by June 30, 2029 .