Sec. 2. Codifying value-based purchasing arrangements under Medicaid and reforms related to price reporting under such arrangements
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Section 1927(c)(1)(C)(ii) of the Social Security Act ( 42 U.S.C. 1396r–8(c)(1)(C)(ii) ) is amended— in subclause (IV), by striking and at the end; in subclause (V), by striking the period and inserting ; and ; and by adding at the end the following new subclause: may include multiple best price points for a single dosage form and strength of a drug of a manufacturer subject to a value-based purchasing arrangement (as defined in subsection (k)(12)), but only if such manufacturer offers such arrangement to all States. .
Nothing in the amendments made by this subsection may be construed to prohibit a manufacturer from treating a value-based purchasing arrangement as a bundled sale. Section 1927(k)(1) of the Social Security Act ( 42 U.S.C. 1396r-8(k)(1) ) is amended— in subparagraph (B)(i)— in subclause (VII), by striking at the end and ; in subclause (VIII), by striking the period at the end and inserting ; and ; and by adding at the end the following new subclause: with respect to such covered outpatient drug that is sold under a value-based purchasing arrangement (as defined in paragraph (12)) during the rebate period, including such drug that is an inhalation, infusion, instilled, implanted, or injectable drug that is not generally dispensed through a retail community pharmacy— a refund, rebate, reimbursement, or free goods from the manufacturer or third party on behalf of the manufacturer; or the withholding or reduction of a payment to the manufacturer or third party on behalf of the manufacturer; that is triggered by a patient who fails to achieve outcomes or measures defined under the terms of such value-based purchasing arrangement during the period for which such arrangement is effective. ; and by adding at the end the following new subparagraph:
For purposes of subparagraph (A), in determining the average price paid to the manufacturer for a covered outpatient drug that is sold under a value-based purchasing arrangement (as defined in paragraph (12)) that provides that payment for such drug is made in installments over the course of such agreement, such price shall be determined as if the aggregate price per the terms of the agreement was paid in full in the first installment during the rebate period. . Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall implement the amendments made by this subsection through rulemaking.
Section 1927(k) of the Social Security Act ( 42 U.S.C. 1396r-8(k) ) shall be amended by adding at the end the following paragraph: The term value-based purchasing arrangement has the meaning given such term in section 447.502 of title 42, Code of Federal Regulations (or any successor regulation). .
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- 42 USC 1396r–8(c)(1)(C)(ii)
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Sec. 2
Codifying value-based purchasing arrangements under Medicaid and reforms related to price reporting under such arrangements
Cite42 USC 1396r–8(c)(1)(C)(ii)
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