Most Favored Nation Drug Pricing in the U.S.: Comparing GENEROUS, GLOBE and GUARD

Healthcare Economist January 7, 2026
Jason Shafrin

The Trump administration has introduced three most-favored-nation (MFN) drug pricing initiatives designed to link U.S. pharmaceutical costs to prices paid in economically comparable countries. Most-favored-nation pricing requires manufacturers to provide rebates when U.S. prices exceed those in reference nations—a direct response to the persistent gap between U.S. drug prices and those in other developed economies. Three program have been implemented:

• GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model
• GLOBE (Global Benchmark for Efficient Drug Pricing) Model
• GUARD (Guarding U.S. Medicare Against Rising Drug Costs) Model

I summarize and compare each of these programs below.

GENEROUS: Medicaid’s Voluntary Option

GENEROUS (GENErating cost Reductions fOr U.S. Medicaid Model) represents the first voluntary MFN framework adopted by government payers in the...

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