MVP Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7871 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 7871

  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.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             March 9, 2026

Mr. Guthrie (for himself, Mr. Auchincloss, Mrs. Miller-Meeks, Mr. Joyce
     of Pennsylvania, Mr. Peters, and Mr. Davis of North Carolina)
 introduced the following bill; which was referred to the Committee on
   Energy and Commerce, and in addition to the Committee on Ways and
 Means, for a period to be subsequently determined by the Speaker, in
   each case for consideration of such provisions as fall within the
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

  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.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid VBPs for Patients Act'' or
the ``MVP Act''.

SEC. 2. CODIFYING VALUE-BASED PURCHASING ARRANGEMENTS UNDER MEDICAID
              AND REFORMS RELATED TO PRICE REPORTING UNDER SUCH
              ARRANGEMENTS.

    (a) Codifying Multiple Best Price Points.--
            (1) In general.--Section 1927(c)(1)(C)(ii) of the Social
        Security Act (42 U.S.C. 1396r-8(c)(1)(C)(ii)) is amended--
                    (A) in subclause (III), by adding a semicolon at
                the end;
                    (B) in subclause (IV), by striking ``and'' at the
                end;
                    (C) in subclause (V), by striking the period and
                inserting ``; and''; and
                    (D) by adding at the end the following new
                subclause:
                                    ``(VI) may include multiple best
                                price points for a single dosage form
                                and strength of a drug of a
                                manufacturer subject to a value-based
                                purchasing arrangement (as defined in
                                subsection (k)(12)), but only if such
                                manufacturer offers such arrangement to
                                all States.''.
            (2) Rule of construction.--Nothing in the amendments made
        by this subsection may be construed to prohibit a manufacturer
        from treating a value-based purchasing arrangement as a bundled
        sale.
    (b) Definition of Average Manufacturer Price.--
            (1) In general.--Section 1927(k)(1) of the Social Security
        Act (42 U.S.C. 1396r-8(k)(1)) is amended--
                    (A) in subparagraph (B)(i)--
                            (i) in subclause (IV), by adding a
                        semicolon at the end;
                            (ii) in subclause (VII), by striking at the
                        end ``and'';
                            (iii) in subclause (VIII), by striking the
                        period at the end and inserting ``; and''; and
                            (iv) by adding at the end the following new
                        subclause:
                                    ``(IX) with respect to a covered
                                outpatient drug that is sold under a
                                value-based purchasing arrangement (as
                                defined in paragraph (12)) during the
                                rebate period, including such a drug
                                that is an inhalation, infusion,
                                instilled, implanted, or injectable
                                drug that is not generally dispensed
                                through a retail community pharmacy--
                                            ``(aa) a refund, rebate,
                                        reimbursement, or free goods
                                        from the manufacturer or third
                                        party on behalf of the
                                        manufacturer; or
                                            ``(bb) the withholding or
                                        reduction of a payment to the
                                        manufacturer or third party on
                                        behalf of the manufacturer;
                                that is triggered by a patient who
                                fails to achieve outcomes or measures
                                defined under the terms of such value-
                                based purchasing arrangement during the
                                period for which such arrangement is
                                effective.''; and
                    (B) by adding at the end the following new
                subparagraph:
                    ``(D) Special rule for certain value-based
                purchasing arrangements.--For purposes of subparagraph
                (A), in determining the average price paid to a
                manufacturer for a covered outpatient drug that is sold
                under a value-based purchasing arrangement (as defined
                in paragraph (12)) that provides that payment for such
                drug is made in installments over the course of such
                arrangement, such price shall be determined as if the
                aggregate price per the terms of the arrangement were
                paid in full in the first installment during the rebate
                period.''.
            (2) Rulemaking.--Not later than 180 days after the date of
        the enactment of this Act, the Secretary of Health and Human
        Services shall implement the amendments made by this subsection
        through rulemaking.
    (c) Definition of Value-Based Purchasing Arrangement.--Section
1927(k) of the Social Security Act (42 U.S.C. 1396r-8(k)) is amended by
adding at the end the following paragraph:
            ``(12) Value-based purchasing arrangement.--The term
        `value-based purchasing arrangement' has the meaning given such
        term in section 447.502 of title 42, Code of Federal
        Regulations (or any successor regulation).''.

SEC. 3. CALCULATION OF AVERAGE SALES PRICE UNDER MEDICARE.

    Section 1847A(c)(3) of the Social Security Act (42 U.S.C. 1395w-
3a(c)(3)) is amended--
            (1) by striking ``In calculating'' and inserting the
        following:
                    ``(A) In general.--Subject to subparagraph (B), in
                calculating''; and
            (2) by adding at the end the following new subparagraph:
                    ``(B) Certain remuneration under value-based
                purchasing arrangements excluded.--In calculating the
                manufacturer's average sales price under this
                subsection for a drug or biological that is sold under
                a value-based purchasing arrangement (as defined in
                section 1927(k)(12)) and with respect to which the
                manufacturer of such drug or biological has elected to
                include multiple best price points (as described in
                section 1927(c)(1)(C)(ii)(VI)) in reporting the best
                price of such drug under section 1927(b), such
                manufacturer's average sales price shall not include
                any amount that is excluded from the calculation of the
                average manufacturer price of such drug or biological
                under section 1927(k)(1)(B)(i)(IX).''.

SEC. 4. GUIDANCE ON VALUE-BASED PURCHASING ARRANGEMENTS FOR INPATIENT
              DRUGS UNDER MEDICAID.

    Not later than 180 days after the date of the enactment of this
Act, the Secretary of Health and Human Services shall issue guidance to
State Medicaid agencies on the option of entering into a value-based
purchasing arrangement (as defined in section 1927(k)(12) of the Social
Security Act (42 U.S.C. 1396r-8(k)(12))) with manufacturers for drugs
or biological products provided as part of, or as incident to and in
the same setting as, inpatient hospital services furnished under a
State plan under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.), or under a waiver of such plan, where such drugs or
biological products are reimbursed directly and not paid for as part of
payment for such inpatient hospital services, including guidance on how
multiple States may enter into agreements with one another and with
manufacturers which permit the transfer of funds between the
participating States so that individuals who reside in a State
different from the State in which they receive a drug subject to a
value-based purchasing arrangement as an inpatient may be treated as if
they received such drug in the State in which they reside.

SEC. 5. EXCEPTION UNDER THE ANTIKICKBACK STATUTE.

    (a) In General.--Section 1128B(b)(3) of the Social Security Act (42
U.S.C. 1320a-7b(b)(3)) is amended--
            (1) in subparagraph (J), by moving the left margin of such
        subparagraph 2 ems to the left;
            (2) in subparagraph (K)--
                    (A) by moving the left margin of such subparagraph
                2 ems to the left; and
                    (B) by striking ``and'' at the end;
            (3) in subparagraph (L)(iii), by striking the period and
        inserting ``; and''; and
            (4) by adding at the end the following new subparagraph:
                    ``(M) any remuneration provided by a manufacturer
                or third party on behalf of a manufacturer to a State
                under a value-based purchasing arrangement (as defined
                in section 1927(k)(12)) under a State plan under title
                XIX (or waiver of such plan) in the case a patient
                fails to achieve outcomes or measures defined in such
                arrangement following the administration of a covered
                outpatient drug (as defined in section 1927(k)(2)).''.
    (b) Rulemaking.--Not later than 180 days after the date of the
enactment of this Act, the Inspector General of the Department of
Health and Human Services shall through rulemaking implement the
amendments made by this section.

SEC. 6. GAO STUDY AND REPORT ON USE OF VALUE-BASED PURCHASING
              ARRANGEMENTS.

    (a) Study.--The Comptroller General of the United States shall
conduct a study on the extent to which value-based purchasing
arrangements (as defined in section 1927(k)(12) of the Social Security
Act (42 U.S.C. 1396r-8(k)(12))) facilitate patient access to covered
outpatient drugs, improve patient outcomes, lower overall health system
costs, and lower costs for patients in Federal health care programs. In
conducting such study, the Comptroller General shall--
            (1) study the impact of this Act on--
                    (A) access to transformative therapies, including
                rare disease gene therapies, generally;
                    (B) mitigating socioeconomic disparities in
                accessing covered outpatient drugs sold under value-
                based purchasing arrangements through its requirement
                that State Medicaid programs have access to the same
                value-based purchasing arrangement pricing structure
                that are available in the commercial market for such
                drugs;
                    (C) the Medicaid drug rebate program under section
                1927 of the Social Security Act (42 U.S.C. 1396r-8),
                the 340B drug pricing program under section 340B of the
                Public Health Service Act (42 U.S.C. 256b), and part B
                of title XVIII of the Social Security Act (42 U.S.C.
                1395j et seq.), including compliance with such
                programs;
                    (D) expenditures under State Medicaid programs; and
                    (E) prices for such drugs under the Medicaid
                program in States that do not enter into such
                arrangements;
            (2) analyze all the types of value-based purchasing
        arrangement pricing structures, which structures are working
        well (as measured by price and ease of implementing), and which
        need improvement; and
            (3) study the potential long-term savings for States that
        enter into such arrangements under State Medicaid programs.
    (b) Report.--Not later than June 30, 2029, the Comptroller General
of the United States shall submit to Congress a report containing the
results of the study conducted under subsection (a).
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