Value in Medicaid
The Medicaid VBPs for Patients (MVP) Act (H.R. 2666) is an important bipartisan bill that will enhance Medicaid patient access to new, high-cost therapies, such as cell and gene therapies, by modernizing the framework for value-based purchasing arrangements in Medicaid. It also protects Medicaid from paying for high-cost treatments that are not effective. The MVP Act codifies the existing “multiple best price” rule that allows manufacturers to report multiple best prices for drugs that are subject to value-based purchasing arrangements when certain other criteria are met.
The MVP Act clarifies that the best price under a value-based arrangement is the maximum possible price paid, assuming all patient outcome benchmarks are satisfied. Importantly, this does not mean that Medicaid programs are prohibited from collecting rebates or other price concessions under a value-based arrangement when the treatment fails to meet its benchmarks. The bill also expands the use of value-based agreements to drugs administered in an inpatient setting. The current multiple best price rule only applies to outpatient drugs, limiting Medicaid beneficiary access to therapies that require physician administration. The MVP Act further updates requirements for manufacturers to report information related to pricing structures for value-based arrangements to the Centers for Medicare & Medicaid Services (CMS).
AMCP strongly supports the MVP Act. The MVP Act ensures that the proper channels exist to connect Medicaid patients with the therapies they need. 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.
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