The Centers for Medicare & Medicaid Services announced a five‑year voluntary drug payment model for state Medicaid programs that aims to tie Medicaid outpatient drug prices to selected international benchmarks. Under the Generating Cost Reductions for U.S. Medicaid (GENEROUS) model, participating manufacturers negotiate prices with CMS and states enroll on a rolling basis; manufacturers accepted into the program could receive invoices from states for supplemental rebates to match international prices. CMS said the model will seek to reduce Medicaid drug spending, which topped $100 billion in 2024; industry groups warn that aggressive international‑referenced pricing could affect R&D incentives and market behavior. Clarification: negotiated supplemental rebates are payments manufacturers make to states to lower net prices to payers.