New Model Aims to Expand Access to GLP-1 Medications
by ACOI
January 20, 2026
In December, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model designed to enable Medicare Part D plans and state Medicaid agencies to cover GLP-1 medications used for weight management and metabolic health improvement.
The Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model combines access to GLP-1 medications with access to evidence-based lifestyle supports to achieve better long-term health outcomes.
All beneficiaries receiving GLP-1s for weight management will be provided access to a lifestyle support program, provided by the manufacturer at no cost.
Coverage will depend on participation by drug manufacturers, states, or Part D sponsors. Patients will be subject to qualifications set by the negotiations, including certain prior authorization requirements.
Under the model, CMS will negotiate directly with GLP-1 drug manufacturers for lower net prices and standardized coverage terms. Negotiation areas include:
- Guaranteed net pricing and potential out-of-pocket limits for beneficiaries;
- Standardized coverage criteria; and
- Evidence-based lifestyle support offerings.
The coverage for weight loss under the BALANCE Model will launch in Medicaid as early as May 2026 and in Medicare Part D in January 2027. However, Medicare Part D beneficiaries are expected to have access to GLP-1s by July 2026 through a separate short-term demonstration that will serve as a bridge to BALANCE.
Learn more here.