This session presents the considerations for program participation from both the manufacturer and state Medicaid perspective, unpacking who said "yes," who passed, and why. We will examine the most-favored-nation (MFN) pricing requirements that shaped manufacturer decisions, alongside the incentives and hesitations that guided state participation. We will also discuss CMS's role as matchmaker — negotiating terms with manufacturers first, then curating the options states could choose from — and look ahead to what the 2027 renewal cycle might bring for a model built on annual commitments.