CMS proposes new drug pricing model to expand GLP-1 access to those with Medicare Part D and Medicaid

The Centers for Medicare & Medicaid Services Dec. 23 introduced a new drug pricing model for Medicare Part D and Medicaid beneficiaries. The Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth would increase access to glucagon-like peptide-1 (GLP-1) medications - used for weight loss and other health needs - and other healthy lifestyle interventions. As part of the BALANCE model, CMS will negotiate drug pricing and coverage terms on behalf of state Medicaid agencies and Medicare Part D plan sponsors.

State Medicaid agencies can join the model beginning May 2026, and Part D plans in January 2027.