The Centers for Medicare & Medicaid Services unveiled a voluntary five‑year pilot called GENEROUS that will negotiate outpatient Medicaid drug prices based on selected international benchmarks. Manufacturers who opt in will enter price negotiations with CMS; participating states can enroll on a rolling basis to receive rebates from manufacturers to align Medicaid prices with negotiated terms. CMS framed the model as a tool to rein in Medicaid drug spending (which exceeded $100 billion in 2024) and to better align U.S. pricing with other developed nations. The initiative is part of broader federal policy pressure on drug pricing and is expected to influence manufacturer commercial strategies and state Medicaid formularies.