A White House fact sheet says 26 drugmakers, together covering 89% of the branded drug market, have agreements to hold Medicaid net prices at most-favored-nation levels, meaning what certain other wealthy countries pay. The administration projects $64.3 billion in taxpayer savings over the next decade. The Centers for Medicare & Medicaid Services, which runs the program the deals sit inside, still lists the model at the “Announced” stage, so the savings are forecasts rather than booked results.
What the fact sheet claims and where CMS puts the program today
The Sept. 18 fact sheet on lower drug prices for all 50 state Medicaid programs announces the 26 manufacturer agreements and the 89% market share, and credits President Donald J. Trump’s announcement. The vehicle is the GENEROUS model, run by the CMS Innovation Center. Its model page, last updated Sept. 29, lists the stage as “Announced,” says every state Medicaid program plus the District of Columbia and Puerto Rico has applied, and gives state agencies until Sept. 30 to finalize their applications.
The wording matters. The page says states have applied, not that they have signed on, and it describes the model as voluntary for manufacturers and for states. The 26-company count and the $64.3 billion figure come from the White House, and the model page as read does not carry the savings number.
The 26 manufacturers named on the fact sheet
The fact sheet lists the twenty-six drugmakers by name: Pfizer, AstraZeneca, EMD Serono, Eli Lilly, Novo Nordisk, Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Genentech, Gilead Sciences, GSK, Merck, Novartis, Sanofi, Johnson & Johnson, AbbVie, Regeneron, Alcon, Astellas Pharma, BeOne Medicines, BridgeBio, CSL, Kyowa Kirin, Sun Pharma, Teva Pharmaceuticals and UCB. Its timeline shows the deals arriving in stages: a first Pfizer agreement on Sept. 30, 2025, and nine new agreements on Aug. 31, 2026.
CMS moved the application dates more than once. An April 29 CMS alert pushed the manufacturer application deadline from April 30 to June 11, and the state application deadline from July 31 to September 10, with state participation agreements due Sept. 30.
How a supplemental rebate produces a foreign-referenced price
The mechanism is a rebate, not a price list. The model’s request for applications defines the benchmark as the second-lowest country-specific manufacturer-reported net price, adjusted by gross domestic product per capita, drawn from the G-7 countries other than the United States plus Denmark and Switzerland. Manufacturers pay states a supplemental rebate equal to the drug’s wholesale acquisition cost minus the sum of a guaranteed net unit price and the standard Medicaid rebate. States that participate adopt the negotiated terms and the negotiated coverage criteria, and cannot negotiate additional rebates on drugs that receive the international price. KFF adds that states choose which drugs to include and must adopt uniform coverage criteria, including utilization controls such as prior authorization, which means the coverage rules attached to a discounted drug can change along with its price.
Why $64.3 billion is a forecast that starts from a lower base
The fact sheet splits the $64.3 billion into $36.6 billion for the federal government and $27.6 billion for states. KFF researchers Elizabeth Williams, Robin Rudowitz and Rhiannon Euhus, in a May 8 analysis of the model, attribute that figure to White House estimates and note what limits how much new savings are possible. Medicaid already collects large rebates: they reduced gross spending on prescription drugs by 53% on average from fiscal 2019 to 2024, and by 62% for brand drugs. Rebate reductions ranged from under 40% in four states, Kentucky, Oregon, South Dakota and Virginia, to over 90% in Delaware, Mississippi, Nevada and Wyoming.
The CMS model page puts Medicaid net drug spending at $60 billion in 2024. KFF adds that the five biggest drugs, Biktarvy, Humira, Stelara, Dupixent and Ozempic, account for 10% of all Medicaid drug spending, so the outcome depends on which drugs states and manufacturers actually include. The fact sheet’s separate claim of $600 billion in savings across all MFN deals over ten years comes from the Council of Economic Advisers, and is likewise an estimate.
Medicare drug plans are outside this model
For older readers the distinction is direct. The request for applications states that the model applies only to Medicaid, and KFF likewise notes that Medicare is not affected. Medicare drug plans are not part of the model. The fact sheet also cites senior-focused figures: it says a program that began in July let 600,000 seniors obtain obesity treatment at $50 a month and saved $216 million in two months. That is the administration’s claim, and it comes from a different program than the Medicaid rebate model.
The last date on the record is the one on the CMS page: state applications close Sept. 30, and the agency lists the model as announced, with a five-year term running from January 2026 through 2030 on the request for applications.
Keeping Medicare drug costs and denials in order
Medicare beneficiaries who pay for prescriptions often deal with plan rules and cost-sharing that differ by plan, and state programs that help with premiums and drug costs set their own limits and applications. Tracking those details is a task that exists whether or not a drug-pricing model changes.
The Medicare Cost & Coverage Protection Kit includes 51 state Medicare cost-help packs, the new Part D out-of-pocket cap, and a medication and cost tracker for lining up each prescription’s costs with the rules that apply to it.
Click here to get The Medicare Cost & Coverage Protection Kit →
This article was produced with AI assistance and checked against the primary sources linked above.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
