The Centers for Medicare & Medicaid Services unveiled the Generating Cost Reductions for U.S. Medicaid (GENEROUS) model, a five‑year voluntary pilot that will negotiate outpatient drug prices for participating state Medicaid programs by referencing prices in selected other countries. Manufacturers wishing to participate must apply; states can opt in on a rolling basis. Under the program pharmaceutical firms that agree to the negotiated prices will receive supplemental rebate invoices from participating states to align Medicaid prices with the international benchmarks; the CMS will recoup a share via reduced federal spending. Agency officials said the model targets the more than $100 billion in Medicaid prescription spending and is consistent with the administration’s broader “most favored nation” emphasis. Drugmakers warned such approaches could affect investment and market behavior; state uptake and manufacturer participation will determine how quickly the model cuts Medicaid drug costs.