Medicaid: all 50 states apply for lower prices, 40 have signed

All 50 U.S. states have applied to the GENEROUS payment model, CMS announced September 18. Forty had signed, along with Puerto Rico. Washington, D.C., also applied. The remaining agreements can be signed until September 30. [1]

Which prices would change?

The White House describes manufacturer rebates bringing Medicaid’s net prices closer to international benchmarks. Selected brand-name drugs are covered, including oncology, diabetes and asthma treatments. The announcement does not apply indiscriminately to every U.S. prescription. [2]

The Council of Economic Advisers projects US$64.3 billion in savings over ten years. This is a government estimate, not an achieved result. [2]

What patients will be able to observe

KFF notes that Medicaid already limits payments required from beneficiaries. A lower cost to the programme and a lower pharmacy bill are therefore different measures. The organization considers the new models’ effects on spending and coverage uncertain. [3]

The mechanism uses supplemental rebates invoiced to manufacturers by states, under CMS oversight. Savings will need to be assessed against completed agreements and actual payments. [1]

KFF also highlights pressure from new, expensive treatments. Assessing this policy will require tracking both net spending and access to medicines, rather than the announced total alone. [3]