GENEROUS
GENErating cost Reductions fOr U.S. Medicaid
The GENEROUS Model aims to ensure fair and reasonable drug prices for Medicaid through CMS-led negotiations with drug manufacturers. Under the model, manufacturers will provide supplemental rebates to participating states to align Medicaid net prices with what certain other countries pay.
Innovation
Aligns Medicaid net prices with international reference pricing through CMS-led negotiations and supplemental rebates.
The Problem
America pays more for prescription drugs compared to the rest of the world, which costs states and the federal government billions of dollars.
The Solution
Under GENEROUS, for drugs included in the model, participating drug manufacturers will offer prices based on what other select countries pay for prescription drugs covered by the Medicaid program.
Expected Outcomes
GENEROUS aims to reduce Medicaid spending for drugs included in the model and may improve access to these drugs in participating states for people with Medicaid.
Strategy
GENEROUS supports the Innovation Center’s commitment to improve patients’ lives and health, while simultaneously increasing the sustainability of the Medicaid program — providing greater flexibility in state budgets to invest in other resources — through fairer drug prices and securing greater coverage of needed medications that support our most vulnerable populations.
Model Goals
- Ensure fair and reasonable drug prices for Medicaid
- Align Medicaid net prices with what certain other countries pay
- Reduce Medicaid spending for drugs included in the model
- Improve access to drugs in participating states for people with Medicaid
Patient Eligibility
People with Medicaid in participating states.
- Must be enrolled in Medicaid in a participating state
Provider Eligibility
Voluntary participation for drug manufacturers and states.
- Drug manufacturers must submit a Request for Applications (RFA)
- States must submit a State Request for Applications (RFA)
Care Categories
Pharmacology
CMS Benchmarks & Thresholds
operational
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