Semafor reported on 18 September that the administration will announce all 50 states are getting most-favored-nation pricing on certain Medicaid drugs, with the governors of South Dakota, Mississippi and Arkansas hosted to tout it. Written before the event: at 09:40 UTC, no fact sheet, no drug list, no state roster.
Under CMS's GENEROUS model the MFN price is a supplemental rebate stacked on the statutory one, not a replacement, so a state gains max(0, its current Medicaid net − the international reference). Statutory rebates already take 62-77% off brand drugs; 23.1% is the floor, not the price. Participation is voluntary both ways, and CMS lets a state decline any drug that is not cheaper.
A July research letter from Urban and Brigham modelled 82 high-spend brands, put savings at $8.6bn a year, and named three states already beating the modelled MFN price: Oklahoma, North Dakota and Mississippi — whose governor is there.
That score is four months old: $27.6bn state plus $36.6bn federal is the White House economists' 5 May Medicaid line of $64.3bn, re-split. Applications closed 10 September, binding agreements run to the 30th, and the drug list, which is the entire sizing, is unpublished — Lilly, AbbVie and J&J have signed and named nothing.
Semafor — 18 September 2026
Plan, guest list and savings figures: Semafor, 18 September, which printed its own caveat that Medicaid's discounts are already steep. Design, decline right and deadlines: CMS's GENEROUS pages. The 23.1% floor is statute; the deeper figures are MACPAC and KFF. The study is Hwang et al.; the $64.3bn is the Council of Economic Advisers.
