M-7. Value-Based Agreements

HHSC can enter into a value-based agreement by written agreement with a drug manufacturer, based on outcome data or other metrics to which HHSC and the drug manufacturer agree in writing. The value-based agreement is a written agreement linking payment for a drug or product to its value and is consistent with federal and state law and approved by CMS as part of the Medicaid state plan. Agreements may include things of value, including, but not limited to:

  • Rebates
  • Discounts
  • Price reductions
  • Contributions
  • Risk sharing
  • Reimbursements
  • Payment deferral or installment payments
  • Guarantees
  • Patient care
  • Shared savings payments
  • Withholds
  • Bonuses

Refer to the Value-Based Agreement Concept (HHS Form 1402) to submit a proposal.