Value-based payments (VBP) systems shift the focus from traditional fee-for-service models, where health care providers are paid for the volume of services, to a system where they are rewarded for the quality and cost-effectiveness of the care they provide.
VBP models incentivize providers to improve patient outcomes, reduce costs, and improve the overall patient experience, making them a critical tool for promoting high-quality, affordable care.
However, defining and measuring the value of a drug can be complex, especially when considering factors like clinical outcomes, patient characteristics, and population health. Pharmaceutical companies are sometimes unwilling to offer value-based pricing for their products due to concerns that a drug failing for an individual patient could effectively set the best price available to Medicaid at zero dollars, negatively impacting profitability.
The Medicaid VBPs for Patients (MVP) Act (S. 1637)
AMCP supports the MVP Act to enhance patient access to high quality, affordable care—and to improve patient access to new, high-cost therapies such as cell and gene therapies.
• Value-based payment arrangements are a critical tool for promoting patient access to high-quality, affordable care—while also protecting Medicaid programs’ budgets.
• The MVP Act protects Medicaid from paying for high-cost treatments that are not effective.
• Without wider participation in value-based payment agreements, Medicaid programs may be forced to choose between not covering a drug or paying for a treatment that does not have the expected benefit for the patient.
Urge Congress to pass the MVP Act to improve patient access to life-changing, potentially lifesaving, treatments.
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