Presentation (CTI)

OBJECTIVES: Medicaid plays an essential role in the US health care system, covering nearly one-fifth of the US population. With the adoption of a CMS rule allowing manufacturers to report multiple best prices if associated with a value-based purchasing agreement (VBP), many state Medicaid programs have begun adopting various forms of VBPs. Despite the growing interest, few studies have examined the VBPs currently implemented across states. This research aims to identify and summarize the VBP arrangements adopted within US Medicaid programs.
METHODS: A targeted literature review was conducted using PubMed, Google, state Medicaid websites and manufacturer websites. The review included all VBPs implemented prior to November 2025. Search terms combined “Medicaid” with keywords including “innovative contract,” “outcomes-based,” “value-based” and “subscription-based”. For each VBP, we extracted information on the implementation year, state, product name, active ingredient, product type, drug category, manufacturer, disease area, type of VBP arrangements and outcome measured if available. Descriptive analyses were conducted using Microsoft Excel 2022.
RESULTS: Two primary types of VBPs are currently used in Medicaid: subscription-based purchasing and outcomes-based agreements. In 2019, Louisiana and Washington partnered with manufacturers on subscription-based contracts to cap statewide spending on hepatitis C medications at a predetermined amount. Since 2018, 5 states have implemented outcomes-based agreements, including Oklahoma (6), Michigan (6), Massachusetts (4), Colorado (3) and Arizona (1). Among these agreements, gene therapies account for the largest proportion (50%), led by Zolgensma (onasemnogene abeparvovec-xioi; Novartis) entering outcomes-based contracts with 5 states.
CONCLUSIONS: States’ Medicaid programs have increasingly explored outcome-based agreements, with a steady increase over recent years. No new subscription-based purchasing arrangements have been implemented since 2019, suggesting less enthusiasm for this type of VBP. Gene therapies are the most frequently included products in outcome-based agreements.