,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #bfff  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #ah1 #bjbc,mr4 
,gu?rie 7= himself1 ,ms4 ,e%oo1 ,mr4    
,joyce ( ,p5nsylvania1 ,mr4 ,au*9closs1 
,mrs4 ,mill]-,meeks1 & ,mr4 ,pet]s7     
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xix ( !       
,social ,security ,act to codify        
value-bas$ pur*as+ arrangem5ts "u !     
,m$icaid program & re=ms relat$ to price
 report+ "u su* arrangem5ts1 & = o!r    
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,m$icaid ,v,b,ps = ,pati5ts
 ,act or ! ,,mvp ,act4  #b4 ,f9d+s ,!   
,congress f9ds ! foll[+3 7#a7           
,value-bas$ paym5t 7,,vbp7 arrangem5ts  
are a critical compon5t ( a mod]niz$    
reimbursem5t sy/em4 ,by codify+ elem5ts 

( ! rec5tly f9aliz$ 8multiple be/ price0
 policies ( ! ,c5t]s = ,m$ic>e  ,m$icaid
 ,s]vices1 ,congress is en%r9+ a        
su/a9able & flexible paym5t approa* =   
innovative treatm5ts & cures4  7#b7 ,_m 
( ^! treatm5ts1 includ+ g5e !rapies1 are
 diff]5t f traditional ph>maceutical &  
biologic products 9 t !y c (f]          
long-la/+--sometimes lifelong--b5efits =
 pati5ts & long-t]m value = ! heal? c>e 
sy/em alike4  7#c7 ,!re are hundr$s (   
innovative1 curative1 & life-*ang+      
treatm5ts curr5tly 9 developm5t 9 !     
,unit$ ,/ates4 ,h[ev]1 ! curr5t         
reimbursem5t /ructure 0 n design$ ) ^!  
!rapies 9 m9d1 & all[+ = innovative     
paym5t arrangem5ts w spur great]        
developm5t & access to future cures &   
treatm5ts4  7#d7 ,m$icaid is curr5tly   
los+ out on innovative ways to ensure   
pati5ts h access to ^! treatm5ts1 :ile  
private payors cont9ue to see ! value   
provid$ ?r\gh flexible paym5t           
arrangem5ts4  7#e7 ,,vbp arrangem5ts    
include ! ability to pay bas$ on        

evid5ce-bas$ outcomes &1 ov] "t1 spread+
 ! risk across all entities involv$ 9 ! 
contract & ensur+ t ^! (t5 co/ly        
treatm5ts are accessible4  7#f7         
,evid5ce-bas$ outcomes c demon/rate     
decreas$ co/ to ! heal? sy/em & to      
pati5ts1 includ+ r$uc$ hospitalizations 
& l[] utilization ( o!r heal? c>e       
exp5ditures1 includ+ lab "w1 o!r        
m$ications1 & (fice visits4  7#g7 ,by   
all[+ ,v,b,ps 9 ,m$icaid1 ! heal? c>e   
sy/em w cont9ue to move t[>ds quality   
ov] quantity1 hold+ manufactur]s &      
provid]s acc\ntable = ! be/ treatm5t = e
 pati5t4  #c4 ,codify+ value-bas$       
pur*as+ arrangem5ts "u ,m$icaid & re=ms 
relat$ to price report+ "u su*          
arrangem5ts  7a7 ,codify+ ! ,,vbp rule  
,! revision to section #ddg4eje7;a7 (   
title #db1 ,code ( ,f$]al ,regulations1 
relat$ to ! inclusion ( v>y+ be/ price  
po9ts available "u a value-bas$ pur*as+ 
arrangem5t 7z def9$ 9 section           
#aibg7k77#ab7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr-#h7k77#ab71 z    

add$ by subsection 7d7 ( ?is section7 = 
a s+le dosage =m & /r5g? ( a cov]$      
outpati5t drug if a manufactur] (f]s su*
 pric+ /ructure to all ,/ates1 %all h ! 
=ce & effect ( law4  7b7 ,qu>t]ly       
report+ obligation  7#a7 ,9 g5]al       
,section #aibg7;b77#c77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acifr-#h7;b77#c77;,a77 is am5d$-- 7,a7 
9 clause 7iv71 by /rik+ at ! end &2     
7,b7 9 clause 7v71 by /rik+ at ! end !  
p]iod & ins]t+ 2 &2  7,c7 by ins]t+ aft]
 clause 7v7 ! foll[+ new clause3  7vi7 9
 conjunction ) report+ requir$ "u clause
 7i71 9 ! case ( a cov]$ outpati5t drug 
t is sold "u a value-bas$ pur*as+       
arrangem5t 7z def9$ 9 subsection        
7k77#ab77 made available by !           
manufactur] to a ,/ate plan-- 7,i7 !    
pric+ /ructure = su* drug bas$ on       
pre-def9$ outcomes or measures specifi$ 
9 su* value-bas$ pur*as+ arrangem5t2 &  
7,,ii7 ! be/ price = su* cov]$ outpati5t
 drug outside ( a value-bas$ pur*as+    
arrangem5t1 :i* 9 ! ev5t su* drug is    

sold exclusively ?r\gh su* an           
arrangem5t1 means ! l[e/ price available
 net ( any disc\nts or (fsets t are     
unrelat$ to a refund1 rebate1           
reimbursem5t1 free item1 )hold+1 or     
repaym5t made "u a value-bas$ pur*as+   
arrangem5t = su* drug4  2 &  7,d7 by    
add+ at ! end ( ! flu% left matt] at !  
end ! foll[+ new s5t5ce3 ,in=mation     
report$ ) respect to a rebate p]iod "u  
clause 7i77,i7 relat+ to av]age         
manufactur] price & clause 7i77,,ii7    
relat+ to be/ price %all be updat$ = su*
 rebate p]iod if1 subsequ5t to ! date   
su* in=mation 0 report$1 cumulative     
disc\nts1 rebates1 or o!r arrangem5ts   
adju/ su* av]age price actually realiz$ 
or be/ price available to ! ext5t t su* 
cumulative disc\nts1 rebates1 or o!r    
arrangem5ts are n exclud$ "u ?is section
 f ! det]m9ation ( av]age manufactur]   
price or be/ price4  7#b7 ,rules (      
con/ruction ,no?+ 9 ! am5dm5ts made by  
p>agraph 7#a7 %all be con/ru$ z-- 7,a7  
requir+-- 7i7 a ,/ate to ent] into a    

value-bas$ pur*as+ arrangem5t ) a       
manufactur] = a cov]$ outpati5t drug2 or
  7ii7 a manufactur] to ent] into a     
value-bas$ pur*as+ arrangem5t ) a ,/ate 
= a cov]$ outpati5t drug2  7,b7         
prohibit+ a manufactur] f treat+ a      
value-bas$ pur*as+ arrangem5t z a bundl$
 sale2 or  7,c7 preclud+ ! execution ( a
 supplem5tal rebate agreem5t1 z provid$ 
9 section #aibg7;a77#a7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acifr-#h7;a77#a771 = a cov]$ outpati5t 
drug sold "u a value-bas$ pur*as+       
arrangem5t4  7c7 ,def9ition ( av]age    
manufactur] price ,section #aibg7k77#a7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acifr-#h7k77#a77 is am5d$--  
7#a7 9 subp>agraph 7,b77i7-- 7,a7 9     
subclause 7,,iv71 by /rik+ at ! end &2  
7,b7 9 subclause 7,v71 by /rik+ ! p]iod 
at ! end & ins]t+ 2 &2 &  7,c7 by add+  
at ! end ! foll[+ new subclause3  7,,vi7
 9 accordance ) subsection              
7b77#c77;,a77vi71 ) respect to su* cov]$
 outpati5t drug t is sold "u a          

value-bas$ pur*as+ arrangem5t 7z def9$ 9
 p>agraph 7#ab77 dur+ ! rebate p]iod--  
7aa7 a refund1 rebate1 reimbursem5t1 or 
free goods f ! manufactur] or ?ird p>ty 
on behalf ( ! manufactur]2 or  7bb7 !   
)hold+ or r$uction ( a paym5t to !      
manufactur] or ?ird p>ty on behalf ( !  
manufactur]2  t is trigg]$ by a pati5t  
:o fails to a*ieve outcomes or measures 
def9$ "u ! t]ms ( su* value-bas$ pur*as+
 arrangem5t dur+ ! p]iod = :i* su*      
agreem5t is effective4  2 &  7#b7 by    
add+ at ! end ! foll[+ new subp>agraph3 
7,d7 ,special rule = c]ta9 value-bas$   
pur*as+ arrangem5ts ,= purposes (       
subp>agraph 7,a71 9 det]m9+ ! av]age    
price paid to ! manufactur] = a cov]$   
outpati5t drug t is sold "u a value-bas$
 pur*as+ arrangem5t 7z def9$ 9 p>agraph 
7#ab77 t provides t paym5t = su* drug is
 made 9 in/allm5ts ov] ! c\rse ( su*    
agreem5t1 su* price %all be det]m9$ z if
 ! aggregate price p] ! t]ms ( !        
agreem5t 0 paid 9 full 9 ! fir/         
in/allm5t dur+ ! rebate p]iod4  4  7d7  

,def9ition ( value-,bas$ pur*as+        
arrangem5t ,section #aibg7k7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acifr-#h7k77 %all be am5d$ by add+ at !
 end ! foll[+ p>agraph3  7#ab7          
,value-,bas$ ,pur*as+ ,arrangem5t ,! t]m
 value-bas$ pur*as+ arrangem5t means an 
arrangem5t or agreem5t int5d$ to align  
pric+ or paym5ts to an obs]v$ or expect$
 !rapeutic or cl9ical value 9 a select  
population & includes-- 7,a7            
evid5ce-bas$ measures1 :i* sub/antially 
l9k ! co/ ( a cov]$ outpati5t drug to   
exi/+ evid5ce ( effectiv5ess & pot5tial 
value = specific uses ( t product2 or   
7,b7 outcomes-bas$ measures1 :i*        
sub/antially l9k paym5t = ! cov]$       
outpati5t drug to t ( ! drug's actual   
p]=mance 9 pati5t or a population1 or a 
r$uction 9 o!r m$ical exp5ses4  4  #d4  
,calculation ( av]age sales price "u    
,m$ic>e ,section #ahdg;,a7c77#b7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#c;a7c77#b77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,c7   

,sales subject to a value-bas$ pur*as+  
arrangem5t ,sales ( a drug made "u a    
value-bas$ pur*as+ arrangem5t 7z def9$ 9
 section #aibg7k77#ab771 b only if !    
manufactur] ( su* drug has elect$ to    
report multiple be/ prices "u section   
#aibg7;c7 ) respect to su* drug 9       
accordance ) ! revision describ$ 9      
section #c7;a7 ( ! ,,mvp ,act4  4  #e4  
,value-bas$ pur*as+ arrangem5ts =       
inpati5t drugs "u ,m$icaid ,title ,,xix 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif et seq47 is am5d$ by    
add+ at ! end ! foll[+ new section3     
#aidh4 ,value-bas$ pur*as+ arrangem5ts =
 inpati5t drugs  7a7 ,9 g5]al ,not)/&+  
section #aijb7;a77#a7 7relat+ to        
/atewid5ess71 section #aijb7;a77#aj77;b7
 7relat+ to comp>ability71 & any o!r    
provision ( ?is title = :i* ! secret>y  
det]m9es x is necess>y to waive 9 ord]  
to implem5t ?is section1 beg9n+ on      
,janu>y #a1 #bjbd1 ! ,secret>y %all     
e/abli% a program "u :i* ,/ates may     
provide "u _! ,/ate plans "u ?is title  

7includ+ su* a plan op]at+ "u a /atewide
 waiv] "u section #aaae7 m$ical         
assi/ance = drugs furni%$ to individuals
 9 an inpati5t sett+ pursuant to a      
value-bas$ pur%as+ arrangem5t 7z def9$ 9
 section #aibg7k77#ab77 ) manufactur]s (
 su* drugs4  7b7 ,application ( c]ta9   
outpati5t provisions to inpati5t drugs  
7#a7 ,9 g5]al ,"u ! program e/abli%$ "u 
subsection 7a71 ! ,secret>y %all provide
 = ! application ( ! provisions describ$
 9 p>agraph 7#b7 to value-bas$ pur*as+  
arrangem5ts relat+ to drugs adm9i/]$ 9 !
 inpati5t sett+ 9 a mann] simil> to !   
mann] 9 :i* su* provisions w\ld apply if
 su* drugs 7 adm9i/]$ 9 an outpati5t    
sett+4  7#b7 ,provisions describ$ ,!    
provisions describ$ 9 ?is p>agraph are z
 foll[s3 7,a7 ,qu>t]ly price report+    
obligation ,section #aibg7;b77#c77;,e74 
7,b7 ,def9ition ( be/ price ,clauses    
7i77,,vii7 & 7ii77,v7 ( section         
#aibg7;c77#a77;,c74  7,c7 ,def9ition (  
av]age manufactur] price ,subp>agraphs  
7,b77i77,,vi7 & 7,d7 ( section          

#aibg7k77#a74  7,d7 ,anti-kickback &    
physician self-ref]ral safe h>bors      
,section #aabh;,b7b77#c77,l7 & section  
#ahgg7;h77#a77;,c77iv74  7c7 ,c>ve-,out 
( drugs ,9 ! case ( a drug t is sold "u 
a value-bas$ pur*as+ arrangem5t1 !      
,secret>y %all p]mit ,/ates to pay = su*
 drug "u ! t]ms & conditions ( !        
arrangem5t sep>ately f o!r inpati5t     
items & s]vices furni%$ to ! individual4
  7d7 ,multi-,/ate agreem5ts ,"u !      
program e/abli%$ "u subsection 7a71 !   
,secret>y %all p]mit multiple ,/ates to 
ent] into agreem5ts ) "o ano!r & )      
manufactur]s :i* p]mit ! transf] ( funds
 betwe5 ! p>ticipat+ /ates s t          
individuals :o reside 9 a ,/ate diff]5t 
f ! ,/ate 9 :i* !y receive a drug       
subject to an value-bas$ pur*as+        
arrangem5t z an inpati5t may be treat$ z
 if !y receiv$ su* drug 9 ! ,/ate 9 :i* 
!y reside4  7e7 ,con/ruction ,no?+ 9 ?is
 subp>agraph %all be con/ru$ z deem+ a  
drug furni%$ to an inpati5t z be+       
subject to ! drug disc\nt program "u    

section #cdj;,b ( ! ,public ,heal?      
,s]vice ,act4  4  #f4 ,remun]ation 9    
,f$]al heal? c>e programs ,section      
#aabh;,b7b77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77
 is am5d$-- 7#a7 9 subclause 7,j7-- 7,a7
 by mov+ ! left m>g9 ( su* subp>agraph  
#b ems to ! left2 &  7,b7 by /rik+ &    
aft] ! semicolon at ! end2  7#b7 9      
subclause 7,k7-- 7,a7 by mov+ ! left    
m>g9 ( su* subp>agraph #b ems to ! left2
 &  7,b7 by /rik+ ! p]iod at ! end &    
ins]t+ 2 &2 &  7#c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,l7 any       
remun]ation provid$ by a manufactur] or 
?ird p>ty on behalf ( a manufactur] to a
 plan "u a value-bas$ pur*as+ arrangem5t
 7z def9$ 9 section #aibg7k77#ab77 9 !  
case a pati5t fails to a*ieve outcomes  
or measures def9$ 9 su* arrangem5t      
foll[+ ! adm9i/ration ( a cov]$         
outpati5t drug 7z def9$ 9 section       
#aibg7k77#b774  4  #g4 ,,gao /udy &     
report on use ( value-bas$ pur*as+      
arrangem5ts  7a7 ,/udy ,! ,comptroll]   

,g5]al ( ! ,unit$ ,/ates %all conduct a 
/udy on ! ext5t to :i* value-bas$       
pur*as+ arrangem5ts 7z def9$ 9 section  
#aibg7k77#ab7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr-#h7k77#ab77      
facilitate pati5t access to cov]$       
outpati5t drugs1 improve pati5t         
outcomes1 l[] ov]all heal? sy/em co/s1 &
 l[] co/s = pati5ts 9 ,f$]al heal? c>e  
programs4 ,9 conduct+ su* /udy1 !       
,comptroll] ,g5]al %all-- 7#a7 /udy !   
impact ( ?is ,act on-- 7,a7 access to   
trans=mative !rapies1 includ+ r>e       
disease g5e !rapies1 g5]ally2  7,b7     
mitigat+ socioeconomic disp>ities 9     
access+ cov]$ outpati5t drugs sold "u   
value-bas$ pur*as+ arrangem5ts ?r\gh its
 requirem5t t ,/ate ,m$icaid programs h 
access to ! same value-bas$ pur*as+     
arrangem5t pric+ /ructure t are         
available 9 ! comm]cial m>ket = su*     
drugs2 &  7,c7 ! ,m$icaid drug rebate   
program "u section #aibg ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acifr-#h71 ! #cdj;,b drug pric+ program

 "u section #cdj;,b ( ! ,public ,heal?  
,s]vice ,act 7#db ,u4,s4,c4 #bef;b71 &  
"p ,b ( title ,,xviii ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acie;j et
 seq471 includ+ compliance ) su*        
programs2 &  7#b7 us+ data submitt$     
pursuant to clause 7vi7 ( section       
#aibg7;b77#c77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acifr-#h7;b77#c77;,a771 z add$ by      
section #c ( ?is ,act1 analyze all !    
types ( value-bas$ pur*as+ arrangem5t   
pric+ /ructures1 :i* /ructures are work+
 well 7z measur$ by price & ease (      
implem5t+71 & :i* ne$ improvem5t4  7b7  
,report ,n lat] ?an ,june #cj1 #bjbg1 ! 
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report       
conta9+ ! results ( ! /udy conduct$ "u  
subsection 7a74  #h4 ,sunset ,!         
provisions (1 & ! am5dm5ts made by1 ?is 
,act %all h no effect beg9n+ #e ye>s    
aft] ! date ( ! enactm5t ( ?is ,act4 ,! 
prec$+ s5t5ce %all n apply to any       
value-bas$ pur*as+ arrangem5t 9 effect z

 ( ! date t is #e ye>s aft] su* date (  
enactm5t4