; (2) in subparagraph (K)— (A) by moving the left margin of such subparagraph 2 ems to the left; and (B) by striking and at the end; (3) in subparagraph (L)(iii), by striking the period and inserting ; and ; and (4) by adding at the end the following new subparagraph: (M) any remuneration provided by a manufacturer or third party on behalf of a manufacturer to a State under a value-based purchasing arrangement (as defined in section 1927(k)(12)) under a State plan under title XIX (or waiver of such plan) in the case a patient fails to achieve outcomes or measures defined in such arrangement following the administration of a covered outpatient drug (as defined in section 1927(k)(2)). . (b) Rulemaking Not later than 180 days after the date of the enactment of this Act, the Inspector General of the Department of Health and Human Services shall through rulemaking implement the amendments made by this section. 6. GAO study and report on use of value-based purchasing arrangements (a) Study The Comptroller General of the United States shall conduct a study on the extent to which value-based purchasing arrangements (as defined in section 1927(k)(12)) of the Social Security Act ( 42 U.S.C. 1396r–8(k)(12) ) facilitate patient access to covered outpatient drugs, improve patient outcomes, lower overall health system costs, and lower costs for patients in Federal health care programs. In conducting such study, the Comptroller General shall— (1) study the impact of this Act on— (A) access to transformative therapies, including rare disease gene therapies, generally; (B) mitigating socioeconomic disparities in accessing covered outpatient drugs sold under value-based purchasing arrangements through its requirement that State Medicaid programs have access to the same value-based purchasing arrangement pricing structure that are available in the commercial market for such drugs