Bill > S1637

This bill aims to establish and clarify value-based purchasing (VBP) arrangements in the Medicaid program, which are innovative payment models where drug manufacturers are paid based on the actual effectiveness of their medications. The bill introduces several key provisions, including allowing manufacturers to establish multiple "best price points" for a single drug when offering a value-based arrangement to all states, modifying how average manufacturer price is calculated to account for refunds or reductions in payment when patients do not achieve specified health outcomes, and creating a formal definition of value-based purchasing arrangements. Additionally, the bill provides guidance for state Medicaid agencies on implementing these arrangements, particularly for inpatient drugs, and creates an exception to anti-kickback statutes to facilitate such arrangements. The legislation also mandates a comprehensive Government Accountability Office (GAO) study to evaluate the impact of these arrangements on patient access, drug pricing, health outcomes, and overall healthcare costs, with a report due to Congress by June 30, 2029. The bill seeks to promote more flexible and performance-driven drug pricing models that could potentially lower healthcare expenses and improve patient care.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/1637/all-info