CMS To Launch Voluntary Medicaid, Medicare Part D Program To Expand Access To Select GLP-1 Medications

The Centers for Medicare & Medicaid Services (CMS) announced the BALANCE Model (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth), which aims to expand access to select glucagon‐like peptide‐1 (GLP-1) medications and healthy lifestyle interventions. The BALANCE Model will launch in Medicaid as early as May 2026 and in Medicare Part D in January 2027. Model testing will conclude in December 2031.

As part of this voluntary model, CMS will negotiate drug pricing and coverage terms with manufacturers of GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plan sponsors.

Negotiation areas . . .