President Trump announced that all 50 U.S. states, plus Washington, DC and Puerto Rico, will participate in a new Medicaid drug pricing structure designed around most-favored-nation principles. Under the model, manufacturers would provide supplemental rebates to align Medicaid net prices with negotiated benchmarks. The announcement signals a significant scaling of a controversial pricing framework that has major implications for how biopharma accounts for net revenue, rebate liabilities, and lifecycle contracting. For companies with broad specialty portfolios, the expansion can alter expected payer mix and revenue predictability, even if the operational details vary by state implementation. The move also increases pressure on manufacturers to update contracting strategy and forecasting models as Medicaid becomes more tightly linked to the MFN-like structure. Biotech executives will likely treat the rollout as a material planning variable for pricing, concessions, and access negotiations across 2027 and beyond.