On July 4, 2025, President Trump signed H.R. 1, the Reconciliation Bill (aka the “One Big Beautiful Bill Act”) into law, which includes significant policy changes to Medicaid and the Health Insurance Marketplaces.
Medicaid VBPs for Patients Act (MVP Act)
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 (H.R. 7871/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.
Take Action
Urge Congress to pass the MVP Act to improve patient access to life-changing, potentially lifesaving, treatments.
Related
Policymakers frequently target pharmacy benefit managers (PBMs) in a well-meaning attempt to contain rising drug prices, but some proposed changes could have the opposite effect for patients. AMCP encourages PBM reform efforts to focus on common-sense requirements for transparency reporting by PBMs. It’s time for a more nuanced discussion about PBM reform—one that lowers the temperature and puts patients first.
Prescription digital therapeutics (PDTs) are software-based therapies shown to benefit those with mental health conditions like depression. However, many PDTs do not currently fit into one of the statutorily defined coverage categories for the Medicare or Medicaid programs, leaving beneficiaries of those programs—which include some of America’s most vulnerable populations—without access to these effective and accessible treatments. AMCP supports the Access to Prescription Digital Therapeutics Act, an important bipartisan bill that would help remedy this disparity by creating a comprehensive benefit category and expanding Medicare coverage to include PDTs.
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