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CMS BALANCE Model aims to expand access to GLP-1 medications for people with Medicare Part D and MedicaidWhat’s new: Under the BALANCE Model, CMS will negotiate drug pricing with manufacturers of GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plans to enable people to improve their long-term health, potentially preventing chronic disease and disability. Why it matters: GLP-1 drugs are a promising tool to help people with weight loss and improve their overall health, but access to these drugs is uneven because coverage under Medicare and Medicaid is limited. What to expect: CMS is issuing a Request for Applications, soliciting drug manufacturers to participate in negotiations. BALANCE will launch in Medicaid in 2026 as participating states can join the model on rolling basis, from May through December. The Balance Model is anticipated to start in Medicare Part D in January 2027. Prior to the launch of the BALANCE Model, CMS plans to implement a separate Medicare GLP-1 payment demonstration beginning July 2026 that will serve as a short-term bridge to the BALANCE Model. The big picture: By expanding access to GLP-1 drugs, the CMS Innovation Center is fulfilling its mission to help people with Medicare and Medicaid live healthier lives, and promote competition, while protecting federal taxpayers. Additional details: Manufacturers interested in participating in the model should respond to the BALANCE RFA by January 8, 2026. State Medicaid agencies and Part D plans have until January 8, 2026, to submit a Notice of Intent to participate in the BALANCE Model. Find out more: |
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