Agent Survival Guide Podcast Prescription Drug Pricing: MFN & GENEROUS
- iPhone Pocket Brings Back… Pockets.
- CMS Rural Health Transformation Program
- Government Shutdown Update
- Most-Favored Nation Drug Pricing
- CMS GENEROUS Model
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Phone Pocket Brings Back… Pockets.
Articles of Interest – More Pockets
Hart, Jordan. “Apple and Issey Miyake Design $230 Iphone Pocket Inspired by a ‘Piece of Cloth.’” Business Insider, Business Insider, www.businessinsider.com/apple-issey-miyake-design-iphone-pocket-2025-11. Accessed 12 Nov. 2025.
“Crossbody Strap – Sienna.” Apple, www.apple.com/shop/product/mggn4ll/a/crossbody-strap-sienna. Accessed 12 Nov. 2025.
Cross, Greta. “Internet Conflicted over Apple’s $230 Iphone Pocket Case. See New Product.” USA Today, Gannett Satellite Information Network, www.usatoday.com/story/tech/2025/11/11/iphone-pocket-apple-phone-case/87214270007/. Accessed 12 Nov. 2025.
“Introducing Iphone Pocket: A Beautiful Way to Wear and Carry iPhone.” Apple Newsroom, 12 Nov. 2025, www.apple.com/newsroom/2025/11/introducing-iphone-pocket-a-beautiful-way-to-wear-and-carry-iphone/.
Jewiss, Connor. “The Iphone Pocket Is the Apple Accessory You Never Saw Coming.” CNET, www.cnet.com/tech/mobile/the-iphone-pocket-is-the-apple-accessory-you-never-saw-coming/. Accessed 12 Nov. 2025.
Rural Health Transformation Program:“All 50 States Seek to Transform Rural Health with CMS.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/newsroom/press-releases/all-50-states-seek-transform-rural-health-cms. Accessed 12 Nov. 2025.
Muoio, Dave. “All 50 States Submit Applications for $50B Rural Health Transformation Program.” Fierce Healthcare, www.fiercehealthcare.com/providers/cms-opens-state-applications-50b-rural-health-transformation-program. Accessed 12 Nov. 2025.
Government Shutdown Update:
Swenson, Ali. “An Emerging Shutdown Deal Doesn’t Extend Expiring Health Subsidies. Here’s What Could Happen to Them.” AP News, AP News, 10 Nov. 2025, www.apnews.com/article/shutdown-health-tax-credits-affordable-care-act-2b5ae3651ff16783a00e00dc1ce264bf.
“Division A - Continuing Appropriations Act, 2026.” United States Senate Committee on Appropriations, www.appropriations.senate.gov/imo/media/doc/continuing_appropriations_act_2026_bill_text.pdf. Accessed 12 Nov. 2025.
“Division B - Agriculture, Rural Development, Food and Drug Administration, and Related Agency Appropriations Act, 2026.” United States Senate Committee on Appropriations, www.appropriations.senate.gov/imo/media/doc/agfy26conf.pdf. Accessed 12 Nov. 2025.
“Division C - Legislative Branch Appropriations Act, 2026.” United States Senate Committee on Appropriations, www.appropriations.senate.gov/imo/media/doc/lbfy26aconf.pdf. Accessed 12 Nov. 2025.
“Division D - Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2026.” United States Senate Committee on Appropriations, www.appropriations.senate.gov/imo/media/doc/mcvafy26conf.pdf. Accessed 12 Nov. 2025.
“Federal Shutdown Deal Would Wipe out Hard-Won THC Consumables Market in Texas.” Dallas News, The Dallas Morning News, 12 Nov. 2025, www.dallasnews.com/news/politics/2025/11/11/federal-shutdown-deal-would-wipe-out-hard-won-thc-consumables-market-in-texas/.
Caballero, Martín. “Senate Advances Hemp Ban amid Growing Prohibition Fears.” Brewbound, 11 Nov. 2025, www.brewbound.com/news/senate-advances-hemp-ban-amid-growing-prohibition-fears/.
Gringlas, Sam. “Senate Approves Shutdown Ending Legislation, Sending Bill to the House for a Vote.” NPR, NPR, 11 Nov. 2025, www.npr.org/2025/11/10/g-s1-97245/senate-shutdown-vote.
Yarrow, Grace. “Senators Reject Paul’s Hemp Plans.” Politico, www.politico.com/live-updates/2025/11/10/congress/senators-reject-pauls-hemp-plans-00646064. Accessed 12 Nov. 2025.
“Speaker Johnson Won’t Guarantee Vote in House on ACA Subsidies.” ABC7 Los Angeles, 12 Nov. 2025, www.abc7.com/live-updates/government-shutdown-updates-house-speaker-mike-johnson-commits-vote-senate-funding-deal/18139514/entry/18140103/.
Usigan, Ysolt. “THC Ban Hidden in Government Spending Bill Could Shut down Delta-8 Market, so Stock up Now.” VICE, 12 Nov. 2025, www.vice.com/en/article/federal-thc-ban-on-hemp-products/.
Lalljee, Jason. “The Bill to Reopen the Government Would Shut down These THC Products.” AXIOS, www.axios.com/2025/11/12/government-shutdown-bill-thc-hemp-products. Accessed 13 Nov. 2025.
Tsirkin, Julie, and Frank Thorp V. “The Government Shutdown May Last Longer Because of a Fight over Hemp.” NBCNews.Com, NBCUniversal News Group, 10 Nov. 2025, www.nbcnews.com/politics/congress/government-shutdown-may-last-longer-fight-hemp-rcna243075.
Faguy, Ana. “Trump Signs Spending Bill to End Longest Shutdown in US History.” BBC News, BBC, 13 Nov. 2025, www.bbc.com/news/articles/c891nvwvg2zo.
Stech, Katy, et al. “Trump Signs Funding Bill to End Longest US Government Shutdown.” The Guardian, Guardian News and Media, 13 Nov. 2025, www.theguardian.com/us-news/2025/nov/12/house-bill-government-shutdown-vote.
Desjardins, Lisa. “What’s in the Senate Shutdown Deal.” PBS, Public Broadcasting Service, 11 Nov. 2025, www.pbs.org/newshour/politics/whats-in-the-senate-shutdown-deal.
Most-Favored Nation Drug Pricing:
Krishnan, Manisha. “A Proposed Federal THC Ban Would ‘wipe out’ Hemp Products That Get People High.” Wired, 12 Nov. 2025, www.wired.com/story/proposed-federal-thc-ban-would-wipe-out-hemp-products-that-get-people-high/.
“AstraZeneca Announces Historic Agreement with US Government to Lower the Cost of Medicines for American Patients.” AstraZeneca, www.astrazeneca.com/media-centre/press-releases/2025/astrazeneca-announces-historic-agreement-with-us-government-to-lower-the-cost-of-medicines-for-american-patients.html. Accessed 13 Nov. 2025.
Sagonowsky, Eric. “AstraZeneca CEO Visits White House to Formalize MFN Agreement with Trump.” Fierce Pharma, www.fiercepharma.com/pharma/art-deal-az-visit-white-house-formalize-mfn-agreement-trump-msnbc-reports. Accessed 13 Nov. 2025.
“Agent of Record.” Insuranceopedia, 14 Jan. 2025, www.insuranceopedia.com/definition/674/agent-of-record.
“Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients.” The White House, The United States Government, 12 May 2025, www.whitehouse.gov/presidential-actions/2025/05/delivering-most-favored-nation-prescription-drug-pricing-to-american-patients/.
Democrats Defect on the Shutdown - The New York Times, www.nytimes.com/2025/11/10/briefing/democrats-defect-on-the-shutdown.html. Accessed 13 Nov. 2025.
“Fact Sheet: President Donald J. Trump Announces Actions to Lower Costs and Expand Access to in Vitro Fertilization (IVF) and High-Quality Fertility Care.” The White House, The United States Government, 16 Oct. 2025, www.whitehouse.gov/fact-sheets/2025/10/fact-sheet-president-donald-j-trump-announces-actions-to-lower-costs-and-expand-access-to-in-vitro-fertilization-ivf-and-high-quality-fertility-care/.
“Pfizer Reaches Landmark Agreement with U.S. Government to Lower Drug Costs for American Patients.” Pfizer, www.pfizer.com/news/press-release/press-release-detail/pfizer-reaches-landmark-agreement-us-government-lower-drug?cid=em_PfizerNewsroomAlert&ttype=em. Accessed 13 Nov. 2025.
Stiles, Matt. “How Each House Member Voted on Ending the Government Shutdown | CNN Politics.” CNN, Cable News Network, 13 Nov. 2025, www.cnn.com/2025/11/12/politics/house-vote-government-shutdown-vis.
“Lilly and U.S. Government Agree to Expand Access to Obesity Medicines to Millions of Americans.” Lilly Investors, Eli Lilly and Company, 6 Nov. 2025, www.investor.lilly.com/news-releases/news-release-details/lilly-and-us-government-agree-expand-access-obesity-medicines.
“Novo Nordisk Announces Agreement with the U.S. Administration to Bring GLP-1s to More Americans at a Lower Cost.” Novo Nordisk, www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916450. Accessed 13 Nov. 2025.
Kim Constantino, Annika. “Trump Announces Deals with Eli Lilly, Novo Nordisk to Slash Weight Loss Drug Prices, Offer Some Medicare Coverage.” CNBC, CNBC, 6 Nov. 2025, www.cnbc.com/2025/11/06/trump-eli-lilly-novo-nordisk-deal-obesity-drug-prices.html.
Kansteiner, Fraiser, and Eric Sagonowsky. “Updated: Pfizer Offers Price Concessions, $70b US Outlay in Trump’s ‘Most Favored Nation’ Push.” Fierce Pharma, www.fiercepharma.com/pharma/pfizer-plans-offer-price-concessions-trumps-most-favored-nation-push-reports. Accessed 13 Nov. 2025.
CMS Generating Cost Reductions for U.S. Medicaid (GENEROUS) Model:
“CMS Announces New Drug Payment Model to Strengthen Medicaid and Better Serve Vulnerable Americans.” CMS.Gov, Centers for Medicare & Medicaid Services, 6 Nov. 2025, www.cms.gov/newsroom/press-releases/cms-announces-new-drug-payment-model-strengthen-medicaid-better-serve-vulnerable-americans.
“Fact Sheet: President Donald J. Trump Announces Second Deal to Bring Most-Favored-Nation Pricing to American Patients.” Whitehouse.Gov, The United States Government, 10 Oct. 2025, www.whitehouse.gov/fact-sheets/2025/10/fact-sheet-president-donald-j-trump-announces-second-deal-to-bring-most-favored-nation-pricing-to-american-patients/.
“GENEROUS (GENErating Cost Reductions fOr U.S. Medicaid) Model.” CMS.Gov, Centers for Medicare & Medicaid Services, 7 Nov. 2025, www.cms.gov/priorities/innovation/innovation-models/generous.
“Generous Model Request for Applications from Applicable Manufacturers.” Cms.Gov, Centers for Medicare & Medicaid Services, 10 Nov. 2025, www.cms.gov/files/document/generous-rfa.pdf.
“Lilly and U.S. Government Agree to Expand Access to Obesity Medicines to Millions of Americans.” Investor.Lilly.Com, Eli Lilly and Company, 6 Nov. 2025, investor.lilly.com/news-releases/news-release-details/lilly-and-us-government-agree-expand-access-obesity-medicines.
“Novo Nordisk Announces Agreement with the U.S. Administration to Bring GLP-1s to More Americans at a Lower Cost.” Novonordisk.Com, Novo Nordisk, 6 Nov. 2025, www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916450.
Dunleavy, Kevin. “Pharma Eli Lilly, Novo Nordisk Strike Deals with White House to Cut Prices of Weight Loss Drugs.” Fiercepharma.Com, Fierce Pharma, 6 Nov. 2025, www.fiercepharma.com/pharma/eli-lilly-novo-nordisk-strike-deal-white-house-cut-price-weight-loss-drugs.
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Episode Transcript:
You are listening to the Friday Five here on the Agent Survival Guide Podcast. I’m your host, Sarah Rueppel and this is our weekly recap of five headlines that you should know about. Today is November 14th.
We’ll start out this week where we normally do at Number Five.
Last week, the internet absolutely lost its mind over the Starbucks Bearista Bear mug, which was available in very limited quantities. Naturally that led to disappointments, fights between customers, and a whole bunch of hilarious social media posts mocking the whole thing.
And then this week, Apple announced an accessory that made more than a few people scratch their heads. Because really no one asked for it, but the iPhone Pocket is a thing you can order for either one-hundred fifty dollars or two-hundred thirty dollars.
Unlike the iPhone cross-body strap, which to be honest, is actually useful, the iPhone Pocket is literally just that. It’s a sock-like sling for your iPhone that the company claims can also be used to hold AirPods and other small items that you’d likely stick in your pocket.
Personally, I don’t see that turning out too well, but maybe my mind would change if I saw one in person.
The company also showed the short pocket version looped around a bag handle, similar to a clip-on lip gloss or hand sanitizer.
The pockets are described as a quote, “3D-knitted construction” and come from iconic design house Issey Miyake. Same designer as the Bao Bao bags, those duochrome handbags made of little triangles.
I do have to say, I get the fact that this will be instantly recognizable for those carrying it or attaching it to their bag.
And bag charms are super trendy right now. But as far as functional? Eh, I’m just not sold. It’s not like the phone is out and accessible, it’s in a little pouch, or I guess I should call it what it is, a little pocket, seemingly worn just as much for show as it is for function.
It reminds me of the vintage tie-on pockets that women used to hide in their dresses back in the day, which I learned about in an episode of Articles of Interest that we’ll be linking to in the episode notes. Because the history of pockets is actually fascinating, believe it or not.
The iPhone Pocket is available for purchase beginning today at a very small list of 10 stores or online at Apple dot com.
Number Four, super short mention here, but if you’ve got a rural health area in your market, this is important news.
This Wednesday was the deadline for states to submit their applications to the Rural Health Transformation Program, and all 50 states filed bids.
The program is set to distribute ten billion dollars between 2026 and 2030. Five billion dollars will be dispersed evenly between approved states. The other five billion will be awarded according to how each of those approved states meets the goals outlined in their bid pitches.
Approvals will be announced by December 31st of this year.
Coming in at Number Three, we’ve got an update on the government shutdown.
On Sunday night, the Senate held a vote to reopen the government and got there with a 60-40 split.
And then late Wednesday night, the House voted 222 to 209 to approve the Senate version of the funding bill and reopen the federal government.
President Trump signed the deal into law not long after the House vote.
The deal to reopen the government comes with four separate appropriations acts that we’ll be linking to in the episode notes.
There’s the general Continuing Appropriations Act of 2026, and then the more specific Agriculture, Rural Development, and FDA Appropriations Act, the Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, and the Legislative Branch Appropriations Act, all for 2026.
The Continuing Appropriations Act of 2026 included funding for most government agencies, with time frames running from the end of January 2026 up to three years, depending on the agency.
SNAP benefits would be fully funded through September 30, 2026.
For states that paid out any federal expense benefits during the shutdown, they would be reimbursed for those monies, including if they paid out SNAP benefits to their constituents.
One thing missing from all four of those legislative documents? Any update on ACA subsidies, so those are still set to expire at the end of December.
A lot of different ideas have been floated around about how to deal with those expiring subsidies, from the proposal I mentioned in last week’s episode, to many others, including one that would circumnavigate the government and send the money straight to those purchasing plans on the marketplace.
And then a last-minute inclusion that I’ve been reading quite a bit about, reversing the Farm Bill provision of 2018 that loosened federal restrictions on hemp.
In the new Federal funding bill, hemp products cannot contain more than point three percent total THC or more than point four milligrams combined total per container of THC. And this ban covers both naturally and synthetically derived THC.
THC products that are considered “intoxicating” like delta-8 and delta-9 variants seem to be the target here. And then there’s the fact that the industry is unregulated, meaning that variants available from non-reputable sources get lumped in with those who are following the rules and being transparent about sourcing and dosage.
The new ban on hemp products goes into effect one year from signing on November 13th, 2026.
As far as the ACA subsidies, that’s likely to come down to a separate proposal, requiring its own vote in both houses of Congress.
So for now, the longest government shutdown in U.S. history ends
We’ll be keeping an eye on this story as it continues to unfold.
As far as the ACA subsidies, that’s likely to come down to a separate proposal, requiring its own vote in both houses of Congress.
We’ll be keeping an eye on this story as it continues to unfold.
Number Two.
Last week, Eli Lilly and Novo Nordisk joined the list of other American pharmaceutical companies who have joined the Trump Administration’s “Most Favored Nation” drug pricing campaign.
We haven’t talked much about this on the podcast as of yet, so consider this a recap.
At the end of September, Pfizer was the first company to agree to the administration’s call to adjust pricing on existing drugs to that of comparable developed countries, and for pricing on new drugs to also be set at a similar price points as other developed markets.
According to Pfizer’s press release, they plan to offer quote, “the large majority of the company’s primary care treatments and some select specialty brands will be offered at savings that will range as high as eighty-five percent and on average, fifty percent,” end quote.
In order to obtain the savings, consumers will have to use the new direct-to-consumer drug platform, TrumpRx dot gov, which is rumored to launch in 2026.
Later in October 2025, AstraZeneca shored up their deal with the Trump administration. They plan to offer direct-to-consumer sales savings for quote, “eligible patients with prescriptions for chronic diseases at a discount of up to 80% off list prices,” end quote. They committed to participation in Trump Rx dot gov as well, to quote, “allow patients to purchase medicines at a reduced cash price from AstraZeneca,” end quote.
In mid-October, EDM Serono, the US subsidiary of Merck announced that they would offer their IVF treatments through the TrumpRx dot gov direct to consumer platform. EDM Serono named three of their IVF treatments that eligible patients with prescriptions could take advantage of quote, “significantly reduced prices,” end quote. And to get super specific, for patients with prescriptions to all three therapies, quote, “patients will access an 84% discount off list prices,” end quote.
Also answering the call from the Trump administration’s Most Favored Nation drug pricing campaign, Eli Lilly and Novo Nordisk both made announcements about their respective deals last week.
But to keep things spicy, their deals fall under both the broader umbrella of the Most Favored Nation drug pricing campaign and one of its implementation methods – the Generous model, which we’ll get to in a moment.
Eli Lilly announced that, upon FDA approval, they hoped to offer Zepbound and its soon to be released Orforglipron, a GLP-1 in pill form through LillyDirect, their own DTC drug platform. Lilly quoted quite a few prices in their release for self-pay patients. The Zepbound multi-dose pen in the lowest dose will start at two hundred ninety-nine dollars, and additional doses will cost up to four-hundred forty-nine dollars. Multi-dose pen prescriptions will refill at a cost of no more than four-hundred forty-nine dollars. Orforglipron will be priced at one-hundred forty-nine dollars for the lowest dose. Additional doses will run un to three-hundred ninety-nine dollars.
Also coming to LillyDirect as part of the MFN campaign, Emgality, Trulicity, and Mounjaro will also be available for self-pay patients at fifty to sixty percent off current list prices.
Self-pay patients is the operative word there. Self-paying for prescriptions while holding insurance unfortunately doesn’t contribute to your deductible. Depending on the person, that may or may not be a good deal.
Also included in the Lilly release, a reminder that insulin will remain available at the thirty-five dollar per month price point regardless of whether a consumer has insurance or not.
Novo Nordisk agreed to cut prices on their semaglutide medicines, Wegovy and Ozempic on their own DTC – NovoCare. Unlike Eli Lilly, they did not reveal pricing details in their official release.
All five pharmaceutical companies announced participating price reductions in their drugs via their own DTC platforms as well as TrumpRx dot gov, when it launches next year.
I know that we mentioned this previously, but I want to mention it again. These savings that we mentioned may or may not be picked up by insurance companies. All of them mentioned savings associated with self-pay patients, purchase on DTC platforms, or purchase on Trump Rx dot gov. So just something to keep in mind if your clients have questions.
Depending on the diagnoses your client has or doesn’t have to go along with their GLP-1 prescription, that’s going to determine what’s the best course of action for them.
Currently, many insurers will not cover GLP-1s for weight loss unless they have also been diagnosed with obesity or overweight with one condition. The main label use for the medication is for those with Diabetes.
And then the last thing to mention, all five pharmaceutical companies were granted a three-year period of relief from tariffs in exchange for participation in the MFN.
Now, let’s move on to Number One, which is the other half of the Eli Lilly and Novo Nordisk MFN campaign announcement.
Simultaneously, CMS announced a new drug payment model for Medicaid – the Generating Cost Reductions for U.S. Medicaid or Generous Model. And yes, we like to get very creative when we’re coming up with these model names.
This model is how CMS plans to implement the new drug pricing for those on Medicare and Medicaid.
According to CMS, the Generous model will allow the agency to quote, “negotiate with participating manufacturers for lower prices, while states adopting the model will implement uniform, transparent coverage criteria. These consistent standards will give patients and providers predictable access across participating states,” end quote.
Participating states is a key word there as the model is voluntary for both states and drug manufacturers.
According to CMS, drug spending in the Medicaid program is quote, “significant and increasing, with net spending of sixty billion dollars in 2024, an increase of ten billion dollars from 2022,” end quote.
The model aims to keep prescription drugs accessible for those who need them, lowering the price for both patients and the government, with the hopes that medication use will in turn cause better patient outcomes.
Under the Generous model, Ozempic, Wegovy, Mounjaro, and Zepbound GLP-1 medications by Eli Lilly and Novo Nordisk would be available to a select group of Medicare beneficiaries.
And as mentioned earlier, should Orforglipron, Eli Lilly’s oral GLP-1 follow the projected path to FDA approval, it would also be available.
Now, let’s talk about that select group of Medicare beneficiaries, because there’s a reason for wording it that way.
Savings won’t be available on all GLP-1s for all Medicare beneficiaries, though.
Prior to the Generous model, only those with type 2 diabetes or cardiovascular disease could receive coverage for their GLP-1 medications. When implemented, the Generous model will extend coverage to Medicare beneficiaries with obesity.
Beneficiaries with Part D benefits will be phased into model participation through three stages.
Phase 1 will include overweight individuals with a body mass index or BMI or more than 27, prediabetic indvidiuals, or those diagnosed with cardiovascular disease.
Phase 2 incorporates overweight individuals with a BMI greater than 30, individuals with uncontrolled hypertension, kidney disease, or heart failure.
And then Phase 3 will include overweight individuals with a BMI greater than 35.
CMS will launch the Generous Model in January 2026, letting it run for five years. No word yet on the exact timing of those phases, but I’m sure we’ll be hearing from CMS on that front.
As far as Medicaid beneficiaries go, coverage depends on if their state opts in to the Generous Model. CMS is seeking letters of intent from State Medicaid agencies interested in participating.
And last but not least, let’s talk cost.
For Wegovy and Zepbound, starting doses will begin the model priced at three-hundred fifty dollars per month for those in Medicare or on Medicaid. That cost will decrease over two years, no word yet on how much.
Starter doses of Ozempic and Mounjaro will run two-hundred forty-five dollars per month and also decrease over a period of two years.
And then the last pricing detail we have right now, a Medicare beneficiary who qualifies for coverage under either the expanded criteria or Part D Phase-ins outlines by the Generous Model - they will pay just fifty dollars per month for their GLP-1 medication.
Just a reminder that we are still in very early stages of the MFN campaign, Trump Rx dot gov, and the Generous Model. We’ll likely be circling back to this story to update it in future Friday Five episodes, so be sure to follow along with our show so you don’t miss out on any of that information.
And then be sure to visit the episode notes, too. We’ve got links to all the resources we mentioned today, so you’ll find links to all the press releases from CMS, the pharmaceutical companies we talked about, the proposed legislation to get the government up and running again, and even more info on the iPhone Pocket.
Thanks so much for listening to our show this week, little bit of a long one today! That being said, I hope you have a great weekend.
Stay healthy and stay safe out there, and we will see you next week.