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What’s new: State Medicaid agencies and Medicare Part D plan sponsors are now encouraged to apply to participate in the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model, which will lower the cost and expand coverage of select GLP-1 medications for weight management in Medicare Part D and Medicaid.
Why it matters: CMS has successfully completed negotiations with manufacturers Eli Lilly and Novo Nordisk, a significant milestone in carrying out the BALANCE model, and State Medicaid Agencies and Part D plan sponsors can now apply to participate in BALANCE, another critical step to making GLP-1s more affordable and available to people with Medicare Part D and Medicaid.
What to expect: BALANCE will launch in participating states as early as May 2026 and is expected to launch in Medicare Part D in January 2027; however, CMS also has finalized a Medicare GLP-1 payment demonstration, called the “Medicare GLP-1 Bridge,” beginning in July 2026, which will serve as a bridge to the model, allowing people with Medicare Part D coverage who meet certain requirements to access GLP-1 medications starting July 2026.
The big picture: GLP-1s can be transformative for people who may benefit from medication supported weight loss; they have the potential to improve long-term health by preventing, treating, and delaying chronic diseases associated with obesity, such as heart disease and type 2 diabetes. BALANCE makes GLP-1 treatment more affordable and accessible, so that more people with Medicare Part D coverage and Medicaid can live healthier lives, advancing on the MAHA movement.
Additional details: The BALANCE RFAs include details on pricing, cost sharing, clinical criteria, and manufacturer provided access to a lifestyle support program.
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