WASHINGTON, D.C. — All 50 states have applied to participate in the Trump administration’s Medicaid drug-pricing model, expanding an effort to tie net prices for selected medicines to prices paid in other countries and generating an estimated $64.3 billion in federal and state savings over the next decade.
The Centers for Medicare & Medicaid Services announced that the District of Columbia and Puerto Rico also applied to participate in the GENEROUS Medicaid Payment Model. Forty states and Puerto Rico had signed participation agreements as of that date, while remaining states have until Sept. 30 to finalize agreements.
Under the model, participating drug manufacturers provide supplemental rebates on covered outpatient drugs so participating Medicaid programs pay net prices aligned with prices in selected foreign markets. The voluntary program launched in January and is scheduled to run for five years.
The White House characterized the expansion as extending most-favored-nation pricing to Medicaid programs nationwide. Its Council of Economic Advisers estimates the model will reduce Medicaid drug spending by $64.3 billion over 10 years, including $36.6 billion in federal savings and $27.6 billion for states.
The model covers hundreds of drugs across major therapeutic categories, including oncology, diabetes and asthma treatments, according to the administration. CMS indicated that participating manufacturers will be invoiced by states for supplemental rebates, with the agency monitoring pricing accuracy.
President Donald Trump’s administration has reached most-favored-nation agreements with 26 pharmaceutical manufacturers, which the White House says account for about 89% of the U.S. branded-drug market. Those agreements also include provisions covering direct-to-consumer purchases and pricing for newly launched medicines.
The administration estimates its broader drug-pricing agreements could produce about $600 billion in savings over the next decade. That figure is an administration projection rather than realized savings.
The White House also pointed to declining prescription-drug prices as evidence of broader pricing pressure. Bureau of Labor Statistics data show the prescription-drug component of the Consumer Price Index was 2.9% lower in August than a year earlier.
Trump began the current most-favored-nation initiative with a May 2025 executive order directing federal agencies to pursue U.S. prescription-drug prices more closely aligned with those in comparable developed countries. The administration subsequently negotiated agreements with drug manufacturers and launched TrumpRx.gov in February 2026.
The White House says patients have saved more than $700 million through TrumpRx.gov since its launch. That savings figure comes from the administration and was not independently quantified by CMS in its Sept. 18 announcement.
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