Forty states and Puerto Rico have signed on to participate in the GENEROUS Medicaid drug pricing model, with all 50 states, D.C., and Puerto Rico having applied and a September 30 deadline looming for the remaining sign-ons.

Analysts warn that savings are uncertain because many terms are not public, and the benefit to enrollees may be limited since Medicaid already offers low-cost prescriptions.

The White House points to past data, such as a year’s worth of free Eliquis prescriptions under current deals, and frames potential savings as funds that could be redirected to other priorities.

The program runs for five years, beginning in January 2026, and covers hundreds of drugs across major categories including cancer, diabetes, and asthma.

Enrollees may see formulary changes or require prior authorization, and guidance suggests consulting pharmacists or prescribers before stopping any medication.

CMS officials and White House statements project substantial savings, with a White House estimate of $64.3 billion in Medicaid drug savings over 10 years, though state-by-state figures have not yet been published.

The model links prices for covered outpatient brand-name drugs to most-favored-nation prices abroad, with states seeking additional rebates to align final prices with international benchmarks.

The next milestone is the September 30 deadline to finalize sign-ups, with the final participant list and contract terms potentially still in flux.