Background: Value-based care (VBC) focuses on improving patient health outcomes while reducing the overall cost of healthcare. National Comprehensive Cancer Network (NCCN) cancer treatment guidelines standardize and improve quality of care. While studies have shown that compliance to NCCN guidelines improves survival, little information exists regarding the impact of compliance in VBC arrangements. This study aimed to evaluate compliance to NCCN regimen guidelines in Medicare members being treated for cancer under a VBC arrangement. Methods: This is a cohort study of individuals receiving care, in a single state, enrolled in a VBC contract within a large national insurer from February 2023 to October 2023. Medicare members with bladder, colon, lung, melanoma, breast, hepatocellular, rectal, pancreatic, multiple myeloma, gastric, ovarian, esophageal, lymphoma, kidney, leukemia, head and neck, biliary tract and uterine cancer with at least one oncology claim within the contract year were included. NCCN compliance was a quality measure of the VBC. NCCN regimen compliance was identified from pharmacy and medical claims and defined as concordant if the entire prescribed treatment regimen matched an NCCN regimen (Level 1 and 2a); members not receiving an NCCN recommended regimen were deemed to be non-concordant. Results: This study included 561 patients, the mean [SD] age was 75.7 [8.2] years and 286 [51.0%] members identified as male. The total population captured through the automated prior authorization platform yielded 100% NCCN compliance. Conclusions: In this study, individuals receiving chemotherapy participating in a shared savings VBC demonstrated 100% compliance to NCCN guidelines.