I 
118TH CONGRESS 
1ST SESSION H. R. 2666 
To amend title XIX of the Social Security Act to codify value-based pur-
chasing arrangements under the Medicaid program and reforms related 
to price reporting under such arrangements, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 18, 2023 
Mr. GUTHRIE (for himself, Ms. ESHOO, Mr. JOYCE of Pennsylvania, Mr. 
AUCHINCLOSS, Mrs. MILLER-MEEKS, and Mr. PETERS) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee 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 Representa-
tives 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’’. 
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SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) Value-based payment (VBP) arrangements 
are a critical component of a modernized reimburse-
ment system. By codifying elements of the recently 
finalized ‘‘multiple best price’’ policies of the Centers 
for Medicare & Medicaid Services, Congress is en-
shrining a sustainable and flexible payment ap-
proach for innovative treatments and cures. 
(2) Many of these treatments, including gene 
therapies, are different from traditional pharma-
ceutical and biologic products in that they can offer 
long-lasting—sometimes lifelong—benefits for pa-
tients and long-term value for the health care system 
alike. 
(3) There are hundreds of innovative, curative, 
and life-changing treatments currently in develop-
ment in the United States. However, the current re-
imbursement structure was not designed with these 
therapies in mind, and allowing for innovative pay-
ment arrangements will spur greater development 
and access to future cures and treatments. 
(4) Medicaid is currently losing out on innova-
tive ways to ensure patients have access to these 
treatments, while private payors continue to see the 
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value provided through flexible payment arrange-
ments. 
(5) VBP arrangements include the ability to 
pay based on evidence-based outcomes and, over 
time, spreading the risk across all entities involved 
in the contract and ensuring that these often costly 
treatments are accessible. 
(6) Evidence-based outcomes can demonstrate 
decreased cost to the health system and to patients, 
including reduced hospitalizations and lower utiliza-
tion of other health care expenditures, including lab 
work, other medications, and office visits. 
(7) By allowing VBPs in Medicaid, the health 
care system will continue to move towards quality 
over quantity, holding manufacturers and providers 
accountable for the best treatment for every patient. 
SEC. 3. CODIFYING VALUE-BASED PURCHASING ARRANGE-
MENTS UNDER MEDICAID AND REFORMS RE-
LATED TO PRICE REPORTING UNDER SUCH 
ARRANGEMENTS. 
(a) CODIFYING THE VBP RULE.—The revision to 
section 447.505(a) of title 42, Code of Federal Regula-
tions, related to the inclusion of varying best price points 
available under a value-based purchasing arrangement (as 
defined in section 1927(k)(12) of the Social Security Act 
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(42 U.S.C. 1396r–8(k)(12), as added by subsection (d) 
of this section) for a single dosage form and strength of 
a covered outpatient drug if a manufacturer offers such 
pricing structure to all States, shall have the force and 
effect of law. 
(b) QUARTERLY REPORTING OBLIGATION.— 
(1) IN GENERAL.—Section 1927(b)(3)(A) of the 
Social Security Act (42 U.S.C. 1396r–8(b)(3)(A)) is 
amended— 
(A) in clause (iv), by striking at the end 
‘‘and’’; 
(B) in clause (v), by striking at the end 
the period and inserting ‘‘; and’’; 
(C) by inserting after clause (v) the fol-
lowing new clause: 
‘‘(vi) in conjunction with reporting re-
quired under clause (i), in the case of a 
covered outpatient drug that is sold under 
a value-based purchasing arrangement (as 
defined in subsection (k)(12)) made avail-
able by the manufacturer to a State plan— 
‘‘(I) the pricing structure for 
such drug based on pre-defined out-
comes or measures specified in such 
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value-based purchasing arrangement; 
and 
‘‘(II) the best price for such cov-
ered outpatient drug outside of a 
value-based purchasing arrangement, 
which in the event such drug is sold 
exclusively through such an arrange-
ment, means the lowest price available 
net of any discounts or offsets that 
are unrelated to a refund, rebate, re-
imbursement, free item, withholding, 
or repayment made under a value- 
based purchasing arrangement for 
such drug.’’; and 
(D) by adding at the end of the flush left 
matter at the end the following new sentence: 
‘‘Information reported with respect to a rebate 
period under clause (i)(I) relating to average 
manufacturer price and clause (i)(II) relating to 
best price shall be updated for such rebate pe-
riod if, subsequent to the date such information 
was reported, cumulative discounts, rebates, or 
other arrangements adjust such average price 
actually realized or best price available to the 
extent that such cumulative discounts, rebates, 
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