All 50 states, the District of Columbia and Puerto Rico have applied to participate in CMS’s GENEROUS Model, and 40 states and Puerto Rico had signed participation agreements as of CMS’s announcement on Sept. 18. The remaining states have until Sept. 30 to finalize agreements. The voluntary, five-year model is intended to bring Medicaid’s net prices for certain outpatient prescription drugs closer to prices paid in selected other countries. CMS estimates $64.3 billion in taxpayer savings over 10 years; that figure is a projection, not a measured result.
Under the model, participating manufacturers would provide supplemental rebates to participating state Medicaid programs. States would invoice manufacturers quarterly, while CMS would monitor pricing accuracy. In exchange, CMS and manufacturers would negotiate standardized coverage criteria for the included drugs across participating states. CMS says AstraZeneca, Pfizer, and EMD Serono are expected to participate after terms are finalized. The announcement of state participation does not mean every drug or manufacturer is covered.
The model could change the net cost and coverage terms of some drugs used by Medicaid patients, with implications for health systems that manage medication access across inpatient, outpatient and specialty settings. Pharmacy, finance, and contracting teams will need to watch which products enter the model, how states implement the coverage criteria, and whether those changes affect prescribing, prior authorization, and patient access. Those operational effects remain questions to track as agreements take effect.
