President Donald Trump announced that all 50 U.S. states, Washington, DC, and Puerto Rico will participate in a new drug pricing model under Medicaid that relies on supplemental rebates from pharma companies to align net prices. The policy is designed to implement a “most favored nation” style approach inside Medicaid. The update adds scale to an already active debate over drug affordability and federal negotiating power, with implications for payer mix, formulary strategy, and contract terms across commercial and government channels. It also heightens attention on how supplemental rebate mechanics will be calculated and operationalized by manufacturers and state agencies. For biotech and pharma, the near-term impact is likely to show up in pricing assumptions for launch sequencing, portfolio valuation, and revenue forecasts, especially for high-cost specialty products that drive Medicaid spending concentration.