US EditionUS health agency unveils weight-loss drug coverage model
The BALANCE model will lower patient costs to $50 monthly for eligible Medicare enrollees and allow voluntary participation by manufacturers and states to expand GLP-1 drug access.
- CMS launched the BALANCE model earlier this year to expand GLP-1 access in Medicare Part D with voluntary participation for manufacturers, states, and insurers.
- More than 70% of U.S. adults have overweight or obesity, and Medicare's current legal ban on weight-loss drugs has complicated access, though the Biden administration last year proposed reinterpreting the law.
- CMS will negotiate prices with Eli Lilly and Novo Nordisk, and eligible beneficiaries will pay $50 a month, while Medicare covers $245 per drug, tying access to lifestyle supports.
- A short-term demonstration could provide Medicare access to GLP-1s by July, the model's test runs through December 2031, with state Medicaid agencies joining in May 2026 and Part D plans in January 2027.
- Some states are dropping or restricting GLP-1 coverage due to high costs, even as 16 state Medicaid programs reported coverage as of October 1.
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U.S. caps Ozempic-style weight-loss drugs at $50/month for Medicare patients, slashing costs from $1,000 * WorldNetDaily * by WND Staff
Source link Dec 24, 2025: 6:05 a.m.: U.S. caps Ozempic-style weight-loss drugs at $50/month for Medicare patients, slashing costs from $1,000 THE U.S. JUST CAPPED OZEMPIC-STYLE DRUGS AT $50 A MONTH – AND IT CHANGES EVERYTHING The U.S. government is moving to cap weight-loss drugs like Wegovy and Zepbound at $50 per month for people on
CMS Unveils Model to Expand Coverage of Certain Weight Loss Drugs
The Centers for Medicare & Medicaid Services (CMS) on Monday unveiled a voluntary model designed to expand access to GLP-1 medications for weight management and metabolic health, allowing Medicare Part D plans and state Medicaid agencies to cover these drugs while negotiating lower prices to manage expenses. The Better Approaches to Lifestyle and Nutrition for Comprehensive Health (BALANCE) Model aims to combine GLP-1 drugs with evidence-based l…
US health agency unveils weight-loss drug coverage model
The U.S. Centers for Medicare and Medicaid Services on Tuesday unveiled a voluntary program to cover GLP-1 drugs for weight-loss and diabetes under Medicaid and Medicare Part D plans, following the Trump administration's price-cut deal.
Medicare opens door to covering blockbuster drugs for weight loss
Some Medicare enrollees may soon be able to access super-popular drugs for obesity under a voluntary model program, the Centers for Medicare and Medicaid Services announced Tuesday. Eligible beneficiaries will only have to pay $50 a month.
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