| The Trump administration on Friday announced that all 50 states, Washington, D.C., and Puerto Rico have applied to participate in the GENEROUS model, its temporary Medicaid experiment to give states access to prescription drugs at prices tied to what other wealthy countries pay. President Donald Trump made the announcement in an Oval Office briefing, surrounded by top administration health officials and a few governors, including Arkansas Gov. Sarah Huckabee Sanders (R), who served in the White House during Trump’s first term. “That’s extraordinary, but it’s also common sense,” Abe Sutton, who leads the innovation center at the Centers for Medicare and Medicaid running the experiment, said about the universal state participation. “Lower drug prices help every American. It should not be a partisan issue.” Why it matters: The policy, tied to the administration’s most-favored-nation (MFN) pricing agreements with at least 27 companies, has been a major part of the president’s messaging on affordability ahead of the midterm elections. “This will save states billions and billions of dollars per year on drugs and allow them to invest those savings in providing better health care and higher-quality service for the American people,” Trump said at the briefing Friday. “This one thing alone should win us the midterms. It won’t because the press doesn’t report it.” (Hi, hello. It’s me, reporting.) But it’s still unclear how much the pilot program will actually save states, which already receive big discounts on medications through Medicaid. Part of the uncertainty is because we don’t know which drugs are being offered to states at an internationally benchmarked discount, how much they’ll cost and what restrictions are being placed on coverage. The benefit is mostly meant for governments, as patients in Medicaid — a federal-state program for low-income people — already pay nothing or very small amounts for their medications. Mississippi Gov. Tate Reeves (R) said at the Oval Office briefing that his state spends nearly $700 million each year on prescription drugs for its Medicaid program, representing 10 percent of Mississippi’s state budget general fund. “When we combine the ability … to negotiate and give states the flexibility to operate, big things happen,” Reeves said. The pharma component: Drugmakers select which prescription drugs from their portfolios will be available through the GENEROUS model and negotiate with CMS to determine what criteria patients need to meet to get it. And the details of each MFN deal have been mostly confidential. CMS tells me that it will be announcing the overall participation from drugmakers in the GENEROUS model “soon.” → But Friday’s announcement doesn’t necessarily mean that every state is opting in, per a CMS webpage about the model. Now that states have applied to participate in GENEROUS, they have until Sept. 30 to review the details and enter into participation agreements with the Trump administration. - These agreements are just the first step: Once states finalize agreements with CMS, they have to enter into CMS-authorized supplemental rebate agreements with individual drugmakers that lock down the specifics about products, prices and coverage requirements.
- Here’s how that works: Under the parameters of the GENEROUS model outlined by CMS, states can choose which prescription drugs they want among those being offered. Manufacturers then provide a supplemental rebate for those products, which is intended to bring the Medicaid net price down to the negotiated MFN price. If states are already getting a better deal from existing Medicaid rebates, they’re able to maintain those agreements.
Zoom out: While a recent analysis published in JAMA found international prices were lower than Medicaid net prices for 82 brand-name drugs examined by researchers, the actual savings under GENEROUS will largely depend on the medications included in the model. → There’s also the question of how much these deals will impact drug companies overall. Some Wall Street analysts have pointed out that Medicaid represents a relatively small share of the sales for several of the companies that have signed onto the administration’s pricing push. I should also note that Trump made a brief digression into vaccine policy at the Oval Office briefing. He said he wants to further recommend spacing out shots for children even more than previously floated and reduce the overall number of vaccines recommended. “The vaccine size will be much, much less, and I think you’re going to see a massive reduction in autism, and that’s a big deal,” Trump said. “We’re going to be recommending that — and actually demanding it. You can have 1-2-3-4-5, spread out over six months. Every six months, they’ll be fully vaccinated in much smaller doses.” There’s been no evidence to support a link between vaccines and autism. World leaders and executives will come together next week in Midtown Manhattan to set the international agenda for the next year. It’s the U.N. General Assembly’s High-Level Week — considered the world’s biggest diplomatic gathering, where delegations conduct rapid, successive bilateral meetings behind closed doors and convene on the world’s most pressing issues. I’m Nour Wood, a researcher and reporter at WP Intelligence (and passable former Model U.N. chair), and I’ll be locking in on global health policy issues while in New York for this event. For some in Washington, it may seem like a strange time to be thinking internationally, as the Trump administration formally exited the World Health Organization (WHO) earlier this year, and has overhauled its approach to foreign aid in the wake of massive cuts to global health funding. But the international community is rallying. Whatever policy shifts in D.C. may be, the past year has shown that traditional alliances and relationships don’t mean the same as they used to. International organizations and member states are adjusting, cutting, and prioritizing domestic budgets and strengthening regional alliances — where possible — around the globe. Here are three of the biggest themes to watch: 1. Pandemic preparedness World leaders are coming together to try and build a multilateral framework on pandemic preparedness while an Ebola epidemic continues in the Democratic Republic of Congo and Uganda. The central event next week is the second high-level meeting on pandemic prevention, preparedness and response, building on the efforts of the first such meeting in 2023. Why it matters: It’s been three years since the WHO first met on the topic and declared the end of the covid-19 pandemic as a global health emergency. Progress has since stalled. Zoom out: The Global South came out of the pandemic pushing for more equitable distribution of vaccines and waivers for intellectual property rights to help produce generic drugs. Instead, 2023’s high-level meeting and the subsequent WHO Pandemic Agreement produced limited binding commitments and were bogged down by political infighting. The crises that have come since, namely the ongoing Mpox and Ebola epidemics in the Democratic Republic of Congo, have not inspired confidence in the international community’s resilience were we subject to another global pandemic. Regional organizations including the Africa Centres for Disease Control and Prevention have had to combat the crises with limited Western support, making significant but not definite progress on ending the epidemics. Elizabeth Cameron, a professor at and senior adviser to Brown University’s Pandemic Center, pointed out gaps in response financing, including “under-prioritized products like diagnostics, therapeutics and personal protective equipment, as well as vaccines.” What to watch: Advocates for bolstering pandemic preparedness and response are hoping for more binding commitments from next week’s meeting, with a focus on prioritized financing, as well as the creation of international monitoring and accountability systems to ensure effective outcomes to stave off the next pandemic. 2. International aid fallout International institutions are also grappling with the United States’ retreat from global health funding. The resulting gap, estimated at around $12.7 billion in a 2025 KFF analysis, was compounded by similar reductions in global health funding by the United Kingdom, France and Germany in 2025. The United States had provided about 18 percent of WHO’s funding, and its withdrawal caused the organization to cut its workforce by a quarter. The organization has since proposed a leaner budget of $6.2 billion for this year, representing a 14 percent decline from 2025. Countries affected by the cuts are having to scramble. Where possible, they are making the case for restorations of funding, but chances of a return to previous levels are slim. “This is a world where the resource foundation base has dropped 30 to 40 percent. It is not coming back,” said J. Stephen Morrison, director of the Center for Strategic and International Studies’ Global Health Policy Center. What to watch: The old argument that combating health crises abroad secures health at home is no longer persuasive in D.C. and beyond, and funding recipients will have to do their best to prove they can do more with less. 3. Building climate-resilient health systems Climate change is putting additional stress on global health systems: Rising temperatures expand the geographic range of infectious diseases, while the increased frequency of extreme weather events piles pressure on areas of the world that are already strained. It’s not just an international problem either. The U.S. cut data infrastructure programs on climate and health, which is leaving America unprepared, according to Marina Romanello, executive director of Lancet Countdown. “You’ve seen this with the extreme floods over the past few years in Florida and elsewhere, the devastating wildfire seasons throughout the country, and the creeping risk of infectious disease transmission, with diseases like dengue and chikungunya, in the U.S.,” Romanello tells me. What to watch: Next week is going to be a credibility test for international cooperation. International and regional organizations are going to have to bring countries together to combat the cross-border threat of climate change with support for early-warning systems, surveillance and cohesive emergency response before climate shocks hit even harder. The Association of State and Territorial Health Officials (ASTHO) brought on Jane Bigham to serve as senior vice president for government affairs and public relations. → Bigham comes from the Senate Health, Education, Labor, and Pensions Committee, working as the deputy health policy director under Sen. Bernie Sanders (I-Vermont). Her experience also includes more than nine years at the Centers for Disease Control and Prevention. ASTHO also promoted Lindsey Myers to senior vice president for leadership, infrastructure and transformation and Jeffrey Ekoma to vice president of government affairs. “Study finds possibly problematic drug combos being prescribed to older adults,” Erica Sloan writes for The Post. “No, insulin still doesn’t cost $35,” Vox’s Dylan Scott writes in an explainer.
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