; or (bb) 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 (B) by adding at the end the following new subparagraph: (D) Special rule for certain value-based purchasing arrangements For purposes of subparagraph (A), in determining the average price paid to a 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 arrangement, such price shall be determined as if the aggregate price per the terms of the arrangement were paid in full in the first installment during the rebate period. . (2) Rulemaking 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. (c) Definition of value-Based purchasing arrangement Section 1927(k) of the Social Security Act ( 42 U.S.C. 1396r–8(k) ) is amended by adding at the end the following paragraph: (12) Value-Based Purchasing Arrangement 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). . 3. Calculation of average sales price under Medicare Section 1847A(c)(3) of the Social Security Act (42 U.S.C. 1395w–3a(c)(3)) is amended— (1) by striking In calculating and inserting the following: (A) In general Subject to subparagraph (B), in calculating