White House Projects $64.3B in Medicaid Drug Savings Under Voluntary GENEROUS Model, But Manufacturer Deals Remain Secret

President Donald Trump said Friday that all 50 state Medicaid programs will get lower prescription-drug prices through “most-favored-nation” pricing deals, and the White House projected $64.3 billion in savings over a decade. But the plan runs through a voluntary Centers for Medicare and Medicaid Services model, and the manufacturer agreements underpinning the announcement are not public, limiting independent verification of how broad the discounts are or how much they will save.

In a Sept. 18 fact sheet, the White House said “all 50 States’ Medicaid programs will benefit from lower prescription drug prices” under agreements with drugmakers to match the lowest prices paid by other developed nations. The White House Council of Economic Advisers estimated 10-year savings of $64.3 billion, including $36.6 billion for the federal government and $27.6 billion for states. The administration also said the policy will be delivered through the CMS GENEROUS model, cover hundreds of drugs across major classes, and include agreements with 26 pharmaceutical manufacturers representing 89% of the branded drug market. The fact sheet named companies including Pfizer, AstraZeneca, Eli Lilly, Novo Nordisk, Merck, Johnson & Johnson, AbbVie, Regeneron and Teva.

The mechanism is not a new nationwide mandate. CMS announced the GENEROUS model — short for GENErating cost Reductions fOr U.S. Medicaid — in November 2025 and published its request for applications the following month. According to CMS, the model is voluntary for both states and manufacturers: states must apply, and they can choose which participating manufacturers’ drugs to place on their preferred drug lists. CMS designed GENEROUS as a five-year demonstration running from Jan. 1, 2026, through Dec. 31, 2030. It works by adding supplemental rebates on top of the existing Medicaid Drug Rebate Program, rather than replacing the statutory rebate system. CMS says the most-favored-nation benchmark is based on the second-lowest manufacturer-reported net price in a basket of eight countries — the U.K., France, Germany, Italy, Canada, Japan, Denmark and Switzerland — adjusted for differences in GDP per person using purchasing power parity.

The biggest accountability gap is that the full manufacturer agreements cited by the White House have not been publicly posted. That means outside researchers, state officials and budget analysts cannot fully examine the terms, affected drugs or enforcement provisions behind the administration’s savings claims. Reuters, The Associated Press and Semafor have reported that outside analysts and advocates questioned both the size of the projected savings and the lack of public detail. One of the clearest public examples is Bristol Myers Squibb’s disclosure in an SEC filing that, under a December 2025 agreement with the U.S. government, it would provide Eliquis free to Medicaid effective Jan. 1, 2026. Separately, the White House said Medicaid has already benefited from 1 million free Eliquis prescriptions, but that count has not been independently verified.

That matters because Medicaid drug coverage already includes mandatory rebates under the Medicaid Drug Rebate Program, created by Congress in 1990. In practice, GENEROUS is meant to push net prices lower still through additional negotiated rebates, with the most immediate effect likely to show up in federal and state budgets more than in patients’ out-of-pocket costs, which are generally low in Medicaid.

The administration is also using a different route than Trump’s earlier most-favored-nation push. In 2020, the administration tried to tie some Medicare Part B drug payments to international prices through a direct rule. That policy was challenged in court, blocked and later rescinded in 2021. The Medicaid initiative announced Friday instead relies on a voluntary demonstration run through the Center for Medicare and Medicaid Innovation, a narrower administrative vehicle that still leaves key details outside public view.