CMS has unveiled a voluntary payment model for for Medicare Part D plans and state Medicaid agencies to lower the costs of GLP-1 medications.
Under the model, known as Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE), CMS will negotiate directly with manufacturers of GLP-1 drugs for lower net prices.
The two biggest drugmakers selling GLP-1s are Eli Lilly (LLY) and Novo Nordisk (NVO). Lilly markets Mounjaro and Zepbound for, respectively, type 2 diabetes and obesity, while Novo markets Ozempic and Wegovy.
BALANCE could also provide potential out-of-pocket limits for beneficiaries, as well as standardized coverage criteria, and evidence-based lifestyle support offerings.
The model could launch as soon as May 2026 for Medicaid and in January 2027 for Part D.
