SL Insight Newsletter #8

The US will launch the GENEROUS model for Medicaid in 2026: States will be able to purchase drugs at prices aligned with the lowest level of selected reference countries – namely the G7 plus Denmark and Switzerland. Participation is voluntary for manufacturers, starting in January 2026 and running for five years.

What does that mean specifically?

• Pricing strategy in Switzerland: Low prices in SL negotiations could trigger US Medicaid prices; therefore, closely coordinate rebate architecture and timing in Switzerland with US teams.
• Launch & access: Greater incentive to delay SL listings or initially use Art. 71 until US conditions are fixed; risk of longer individual case phases increases.
• Volume control: Stricter limitation texts and quotas can help to avoid or manage Switzerland as the lowest reference price.

Conclusion

Swiss SL prices may in future drive down US Medicaid net prices if they are the lowest within the reference group. This increases global price pressure on products listed in Switzerland and may influence launch sequencing.