The Centers for Medicare & Medicaid Services unveiled the GENEROUS payment model to lower outpatient drug spending in Medicaid by negotiating prices linked to selected international benchmarks. The five‑year voluntary pilot will allow manufacturers to enter negotiations with CMS and participating states to set supplemental rebates that align Medicaid prices with those in other developed countries. CMS framed the model as a tool to rein in rising Medicaid drug spending and free resources for broader care; manufacturers warned of potential impacts on innovation and market dynamics. States may opt in on a rolling basis and the agency will share a portion of rebates through reduced federal Medicaid spending.