Trump announces all 50 states to participate in Medicaid 'most favored nation' drug pricing program

President Donald Trump announced on September 18, 2026, that all 50 states, Washington, D.C., and Puerto Rico will participate in the GENEROUS Medicaid drug-pricing program. The initiative leverages voluntary agreements with 26 pharmaceutical companies to secure 'most favored nation' pricing on hundreds of brand-name drugs. The White House projects the program will save $36.6 billion federally and $27.6 billion for states over a decade, though critics call the pre-election announcement a charade.

GENEROUS Medicaid drug pricing program

• ▪President Donald Trump announced on September 18, 2026, that Medicaid programs in all 50 states, Washington, D.C., and Puerto Rico will participate in the GENEROUS drug discount program.
• ▪Public Citizen's Access to Medicines director Peter Maybarduk criticized the GENEROUS program as a "charade," stating that the Trump administration is obscuring key details and that the price reductions will only last through the end of Trump's term.
• ▪The Centers for Medicare and Medicaid Services stated on September 18, 2026, that 40 states and Puerto Rico had signed agreements for the GENEROUS program, while the remaining states had applied and have until the end of September 2026 to sign.

Most favored nation pricing mechanism

• ▪The GENEROUS program will apply to hundreds of brand-name drugs across major classes, including medications for cancer, diabetes, and asthma.
• ▪Under the GENEROUS program, participating pharmaceutical companies will provide rebates to state Medicaid programs to ensure brand-name drug prices do not exceed "most favored nation" rates paid in other developed countries.
• ▪The Trump administration has negotiated voluntary pricing agreements with 26 major pharmaceutical companies to lower prices for nearly 90% of brand-name drugs.

Projected federal savings

• ▪The White House estimates that the broader "most favored nation" drug-pricing initiative will save the federal government $529 billion over a 10-year period.
• ▪The White House Council of Economic Advisers estimates that the GENEROUS Medicaid drug-pricing program will generate $36.6 billion in federal savings over the next decade.

Projected state savings

• ▪The White House Council of Economic Advisers estimates that the GENEROUS Medicaid drug-pricing program will generate $36.6 billion in federal savings over the next decade.
• ▪Centers for Medicare and Medicaid Services Administrator Mehmet Oz stated that the GENEROUS program will rescue state budgets by reducing the $50 billion in pharmaceutical prices currently paid after rebates.

Midterm election political messaging

• ▪President Donald Trump stated in the Oval Office that the GENEROUS drug-pricing initiative alone should win Republicans the upcoming midterm elections.
• ▪President Donald Trump and Republican officials are promoting the GENEROUS drug-pricing program as a key health care accomplishment ahead of the November 2026 midterm elections.

Debatable claims

• ▪The GENEROUS program will significantly lower Medicaid prescription drug costs
• ▪The Trump administration should disclose the terms of its voluntary drug-pricing agreements