Medicaid VBPs for Patients Act

The Medicaid VBPs for Patients Act

IN THE SENATE OF THE UNITED STATES
MAY 7, 2025
Mr. MULLIN (for himself, Ms. HASSAN, and Mr. S COTT of South Carolina) introduced the following bill; which was referred to the Committee on Finance

SEC. 1. SHORT TITLE

This Act may be cited as the “Medicaid VBPs for Patients Act”.

SEC. 2. FINDINGS AND PURPOSES

(a) Findings—Congress finds that the Medicaid program has been successful in providing healthcare coverage to millions of Americans, but that there are still challenges in ensuring access to care, particularly for rural and underserved populations.

(b) Purposes—The purposes of this Act are to—
(1) improve patient access to covered outpatient drugs;
(2)improve patient outcomes;
(3)lower overall health system costs;
and
(4)lower costs for patients in Federal healthcare programs;

SEC. 3. VALUE-BASED PURCHASING ARRANGEMENTS FOR INPATIENT DRUGS UNDER MEDICAID

(a) In general—
(1)The Secretary shall, in consultation with the Director of the Office of Management and Budget, establish a process for States to enter into value-based purchasing arrangements 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.)

(b) Guidance—
Not later than 180 days after the date of enactment of this Act, the Secretary shall issue guidance to State Medicaid agencies on the option of entering into a value-based purchasing arrangement under 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

SEC. 4. EXCEPTION UNDER THE ANTIKICKBACK STATUTE

(a) In general—
(1)The Secretary shall, in consultation with the Inspector General of the Department of Health and Human Services, clarify that any remuneration provided by a manufacturer or third party on behalf of a manufacturer to a State under a value-based purchasing arrangement under section 1927(k)(12) of the Social Security Act (42 U.S.C. 1396r–8(k)(12)) in the case a patient fails to achieve outcomes or measures defined in such arrangement following the administration of a covered outpatient drug shall be considered lawful

(b) Rulemaking—
Not later than 180 days after the date of 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. 5. GAO STUDY AND REPORT ON USE OF VALUE-BASED PURCHASING ARRANGEMENTS

(a) Study—
(1)The Comptroller General of the United States shall conduct a study on the extent to which value-based purchasing arrangements under 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 healthcare 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)