OBJECTIVES: Recent guidance from the Centers for Medicare and Medicaid Services (CMS) has changed the “best price” reporting rules to ease the development of value-based purchasing arrangements (VPAs) between health technology developers and payers both within and outside Medicaid programs. VPAs are also known as outcomes-, value-, or performance-based contracts or arrangements. Limited documentation on the current use of these arrangements is available. This research aims to identify and characterize previously implemented Medicaid VPAs.

METHODS: A targeted review was conducted from 2017 to 2022 in Embase, Google, PubMed, JMCP, and grey literature to identify publicly disclosed Medicaid VPAs. Search terms were a combination of: Medicaid plus value-, outcomes-, or performance-based contracts, agreements or arrangements. Publications that discussed Medicaid, FDA-approved pharmaceutical or FDA-cleared digital therapies, and search terms were included. Descriptive statistics were used to evaluate the cases identified and included the following categories: year of arrangement, manufacturer, therapeutic area, and outcome measure.

RESULTS: Fourteen VPAs for 6 therapies across 4 states were identified. Oklahoma was the first Medicaid program to develop a pharmacy VPA with a manufacturer in 2018 and has implemented 8 to date. Subsequently, Colorado (2), Massachusetts (3), and Michigan (1) have developed arrangements. All 4 states entered into an arrangement with Novartis for Zolgensma for spinal muscular atrophy. The other drug and digital therapies publicly identified were Aristada, Orbativ, Entresto, reSET and reSET-O. There is limited data on the outcomes of these cases.

CONCLUSIONS: This is the first study to review Medicaid VPAs in the United States. Only a small fraction of states have implemented VPAs to date. With the recent changes implemented by CMS, the number of executed VPAs may increase.