,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ghga  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,m>* #i1 #bjbf,mr4    
,gu?rie 7= himself1 ,mr4 ,au*9closs1    
,mrs4 ,mill]-,meeks1 ,mr4 ,joyce (      
,p5nsylvania1 ,mr4 ,pet]s1 & ,mr4 ,davis
 ( ,nor? ,c>ol9a7 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$icaid ,v,b,ps =     
,pati5ts ,act or ! ,,mvp ,act4  #b4     
,codify+ value-bas$ pur*as+ arrangem5ts 
"u ,m$icaid & re=ms relat$ to price     
report+ "u su* arrangem5ts  7a7 ,codify+
 multiple be/ price po9ts  7#a7 ,9 g5]al

 ,section #aibg7;c77#a77;,c77ii7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acifr-#h7;c77#a77;,c77ii77 is am5d$--  
7,a7 9 subclause 7,,iii71 by add+ a     
semicolon at ! end2  7,b7 9 subclause   
7,,iv71 by /rik+ & at ! end2  7,c7 9    
subclause 7,v71 by /rik+ ! p]iod &      
ins]t+ 2 &2 &  7,d7 by add+ at ! end !  
foll[+ new subclause3  7,,vi7 may       
include multiple be/ price po9ts = a    
s+le dosage =m & /r5g? ( a drug ( a     
manufactur] subject to a value-bas$     
pur*as+ arrangem5t 7z def9$ 9 subsection
 7k77#ab771 b only if su* manufactur]   
(f]s su* arrangem5t to all ,/ates4  4   
7#b7 ,rule ( con/ruction ,no?+ 9 !      
am5dm5ts made by ?is subsection may be  
con/ru$ to prohibit a manufactur] f     
treat+ a value-bas$ pur*as+ arrangem5t z
 a bundl$ sale4  7b7 ,def9ition ( av]age
 manufactur] price  7#a7 ,9 g5]al       
,section #aibg7k77#a7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acifr-#h7k77#a77 is am5d$-- 7,a7 9     
subp>agraph 7,b77i7--  7i7 9 subclause  

7,,iv71 by add+ a semicolon at ! end2   
7ii7 9 subclause 7,,vii71 by /rik+ at ! 
end &2  7iii7 9 subclause 7,,viii71 by  
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7iv7 by add+ at ! end ! foll[+ new      
subclause3  7,,ix7 ) respect to a cov]$ 
outpati5t drug t is sold "u a value-bas$
 pur*as+ arrangem5t 7z def9$ 9 p>agraph 
7#ab77 dur+ ! rebate p]iod1 includ+ su* 
a drug t is an inhalation1 infusion1    
in/ill$1 implant$1 or injectable drug t 
is n g5]ally disp5s$ ?r\gh a retail     
community ph>macy-- 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* arrangem5t 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 a
 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* arrangem5t1
 su* price %all be det]m9$ z if !       
aggregate price p] ! t]ms ( ! arrangem5t
 7 paid 9 full 9 ! fir/ in/allm5t dur+ !
 rebate p]iod4  4  7#b7 ,rulemak+ ,n    
lat] ?an #ahj days aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all implem5t !
 am5dm5ts made by ?is subsection ?r\gh  
rulemak+4  7c7 ,def9ition ( value-,bas$ 
pur*as+ arrangem5t ,section #aibg7k7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acifr-#h7k77 is am5d$ by add+ at ! end 
! foll[+ p>agraph3  7#ab7 ,value-,bas$  
,pur*as+ ,arrangem5t ,! t]m value-bas$  
pur*as+ arrangem5t has ! mean+ giv5 su* 
t]m 9 section #ddg4ejb ( title #db1     
,code ( ,f$]al ,regulations 7or any     
successor regulation74  4  #c4          

,calculation ( av]age sales price "u    
,m$ic>e ,section #ahdg;,a7c77#c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#c;a7c77#c77 is am5d$-- 7#a7 by  
/rik+ ,9 calculat+ & ins]t+ ! foll[+3   
7,a7 ,9 g5]al ,subject to subp>agraph   
7,b71 9 calculat+  2 &  7#b7 by add+ at 
! end ! foll[+ new subp>agraph3  7,b7   
,c]ta9 remun]ation "u value-bas$ pur*as+
 arrangem5ts exclud$ ,9 calculat+ !     
manufactur]'s av]age sales price "u ?is 
subsection = a drug or biological t is  
sold "u a value-bas$ pur*as+ arrangem5t 
7z def9$ 9 section #aibg7k77#ab77 & )   
respect to :i* ! manufactur] ( su* drug 
or biological has elect$ to include     
multiple be/ price po9ts 7z describ$ 9  
section #aibg7;c77#a77;,c77ii77,,vi77 9 
report+ ! be/ price ( su* drug "u       
section #aibg7;b71 su* manufactur]'s    
av]age sales price %all n include any   
am\nt t is exclud$ f ! calculation ( !  
av]age manufactur] price ( su* drug or  
biological "u section                   
#aibg7k77#a77;,b77i77,,ix74  4  #d4     

,guidance on value-bas$ pur*as+         
arrangem5ts = inpati5t drugs "u ,m$icaid
 ,n lat] ?an #ahj days aft] ! date ( !  
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all issue     
guidance to ,/ate ,m$icaid ag5cies on ! 
option ( ent]+ into a value-bas$ pur*as+
 arrangem5t 7z def9$ 9 section          
#aibg7k77#ab7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr-#h7k77#ab777 )   
manufactur]s = drugs or biological      
products provid$ z "p (1 or z incid5t to
 & 9 ! same sett+ z1 inpati5t hospital  
s]vices furni%$ "u a ,/ate plan "u title
 ,,xix ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acif et seq471 or "u a waiv] 
( su* plan1 :]e su* drugs or biological 
products are reimburs$ directly & n paid
 = z "p ( paym5t = su* inpati5t hospital
 s]vices1 includ+ guidance on h[        
multiple ,/ates may 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 a value-bas$ pur*as+ 
arrangem5t z an inpati5t may be treat$ z
 if !y receiv$ su* drug 9 ! ,/ate 9 :i* 
!y reside4  #e4 ,exception "u !         
antikickback /atute  7a7 ,9 g5]al       
,section #aabh;,b7b77#c7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;b7b77#c77 is am5d$-- 7#a7 9  
subp>agraph 7,j71 by mov+ ! left m>g9 ( 
su* subp>agraph #b ems to ! left2  7#b7 
9 subp>agraph 7,k7-- 7,a7 by mov+ ! left
 m>g9 ( su* subp>agraph #b ems to !     
left2 &  7,b7 by /rik+ & at ! end2  7#c7
 9 subp>agraph 7,l77iii71 by /rik+ !    
p]iod & ins]t+ 2 &2 &  7#d7 by add+ at !
 end ! foll[+ new subp>agraph3  7,m7 any
 remun]ation provid$ by a manufactur] or
 ?ird p>ty on behalf ( a manufactur] to 
a ,/ate "u a value-bas$ pur*as+         
arrangem5t 7z def9$ 9 section           
#aibg7k77#ab77 "u a ,/ate plan "u title 
,,xix 7or waiv] ( su* plan7 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    
7b7 ,rulemak+ ,n lat] ?an #ahj days aft]
 ! date ( ! enactm5t ( ?is ,act1 !      
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices %all ?r\gh rulemak+  
implem5t ! am5dm5ts made by ?is section4
  #f4 ,,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#ab777 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$icaid drug rebate     
program "u section #aibg ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acifr-#h71 ! #cdj;,b drug pric+ program
 "u section #cdj;,b ( ! ,public ,heal?  
,s]vice ,act 7#db ,u4,s4,c4 #bef;b71 &  
"p ,b ( title ,,xviii ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acie;j et
 seq471 includ+ compliance ) su*        
programs2  7,d7 exp5ditures "u ,/ate    
,m$icaid programs2 &  7,e7 prices = su* 
drugs "u ! ,m$icaid program 9 ,/ates t d
 n ent] into su* arrangem5ts2  7#b7     
analyze all ! types ( value-bas$ pur*as+
 arrangem5t pric+ /ructures1 :i*        
/ructures are work+ well 7z measur$ by  
price & ease ( implem5t+71 & :i* ne$    
improvem5t2 &  7#c7 /udy ! pot5tial     
long-t]m sav+s = ,/ates t ent] into su* 
arrangem5ts "u ,/ate ,m$icaid programs4 
7b7 ,report ,n lat] ?an ,june #cj1      

#bjbi1 ! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all submit to ,congress a report
 conta9+ ! results ( ! /udy conduct$ "u 
subsection 7a74