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WASHINGTON, D.C. – On December 23, 2025, the Centers for Medicare & Medicaid Services (CMS), through its Innovation Center (CMMI), announced a new, voluntary model designed to enable coverage of GLP-1 medications for weight management along with lifestyle interventions by Medicaid and Medicare Part D plans. Under the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model, CMS will negotiate drug pricing and coverage terms with participating GLP-1 manufacturers on behalf of Medicaid agencies and Medicare Part D plan sponsors. CMS intends to launch the BALANCE model in Medicaid starting May 2026 and in Medicare Part D in January 2027. However, CMS also plans to announce a separate short-term demonstration that will begin as early as July 2026 for Medicare Part D beneficiaries as a bridge to the BALANCE model.
The Diabetes Leadership Council (DLC) and Diabetes Patient Advocacy Coalition (DPAC) applaud the announcement by CMS to test a new approach for reducing prices of and improving access to GLP-1 drugs. However, there are still many unknowns as to how the model will work and what this will mean for coverage of GLP-1 drugs for Medicare and Medicaid beneficiaries. Coverage details, including who will be covered and what drugs will be covered, depend on participation by drug manufacturers, states, and Part D sponsors. Patients will be subject to coverage qualifications determined through negotiations. We also do not know what types of lifestyle interventions will be offered under the model. DLC and DPAC will continue to engage with CMS as more details of the model are announced.
Obesity rates in the U.S. have increased dramatically over the last 30 years, leaving Americans vulnerable to more than 200 other serious health conditions including diabetes, heart disease, high blood pressure, and stroke. DLC and DPAC, along with other patient groups, have advocated for expanded access to GLP-1s to treat obesity for years as part of comprehensive obesity care that also includes intensive behavioral therapy (IBT) and nutrition therapy as well as bariatric surgery. In a poll conducted by DPAC last year, 73% of those polled supported Medicare and Medicaid coverage of GLP-1 medications, including a majority of Republicans, Democrats, and Independents alike.
