‘‘(1) IN GENERAL.—Under the program estab-
lished under subsection (a), the Secretary shall pro-
vide for the application of the provisions described in 
paragraph (2) to value-based purchasing arrange-
ments relating to drugs administered in the inpa-
tient setting in a manner similar to the manner in 
which such provisions would apply if such drugs 
were administered in an outpatient setting. 
‘‘(2) PROVISIONS DESCRIBED.—The provisions 
described in this paragraph are as follows: 
‘‘(A) QUARTERLY PRICE REPORTING OBLI-
GATION.—Section 1927(b)(3)(E). 
‘‘(B) DEFINITION
OF
BEST
PRICE.— 
Clauses 
(i)(VII) 
and 
(ii)(V) 
of 
section 
1927(c)(1)(C). 
‘‘(C) DEFINITION OF AVERAGE MANUFAC-
TURER PRICE.—Subparagraphs (B)(i)(VI) and 
(D) of section 1927(k)(1). 
‘‘(D) 
ANTI-KICKBACK
AND
PHYSICIAN 
SELF-REFERRAL
SAFE
HARBORS.—Section 
1128B(b)(3)(L) and section 1877(h)(1)(C)(iv). 
‘‘(c) CARVE-OUT OF DRUGS.—In the case of a drug 
that is sold under a value-based purchasing arrangement, 
the Secretary shall permit States to pay for such drug 
under the terms and conditions of the arrangement sepa-
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rately from other inpatient items and services furnished 
to the individual. 
‘‘(d) MULTI-STATE AGREEMENTS.—Under the pro-
gram established under subsection (a), the Secretary shall 
permit multiple States to enter into agreements with one 
another and with manufacturers which permit the transfer 
of funds between the participating states so that individ-
uals who reside in a State different from the State in 
which they receive a drug subject to an value-based pur-
chasing arrangement as an inpatient may be treated as 
if they received such drug in the State in which they re-
side. 
‘‘(e) CONSTRUCTION.—Nothing in this subparagraph 
shall be construed as deeming a drug furnished to an inpa-
tient as being subject to the drug discount program under 
section 340B of the Public Health Service Act.’’. 
SEC. 6. REMUNERATION IN FEDERAL HEALTH CARE PRO-
GRAMS. 
Section 1128B(b)(3) of the Social Security Act (42 
U.S.C. 1320a–7b(b)(3)) is amended— 
(1) in subclause (J)— 
(A) by moving the left margin of such sub-
paragraph 2 ems to the left; and 
(B) by striking ‘‘and’’ after the semicolon 
at the end; 
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(2) in subclause (K)— 
(A) by moving the left margin of such sub-
paragraph 2 ems to the left; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(L) any remuneration provided by a man-
ufacturer or third party on behalf of a manu-
facturer to a plan under a value-based pur-
chasing arrangement (as defined in section 
1927(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 (as defined in section 
1927(k)(2)).’’. 
SEC. 7. 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 sys-
tem costs, and lower costs for patients in Federal health 
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care programs. In conducting such study, the Comptroller 
General shall— 
(1) study the impact of this Act on— 
(A) access to transformative therapies, in-
cluding 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; and 
(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; and 
(2) using data submitted pursuant to clause 
(vi) of section 1927(b)(3)(A) of the Social Security 
Act (42 U.S.C. 1396r–8(b)(3)(A)), as added by sec-
tion 3 of this Act, analyze all the types of value- 
based purchasing arrangement pricing structures, 
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which structures are working well (as measured by 
price and ease of implementing), and which need im-
provement. 
(b) REPORT.—Not later than June 30, 2027, the 
Comptroller General of the United States shall submit to 
Congress a report containing the results of the study con-
ducted under subsection (a). 
SEC. 8. SUNSET. 
The provisions of, and the amendments made by, this 
Act shall have no effect beginning 5 years after the date 
of the enactment of this Act. The preceding sentence shall 
not apply to any value-based purchasing arrangement in 
effect as of the date that is 5 years after such date of 
enactment. 
Æ 
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