The U.S. Centers for Medicare & Medicaid Services (CMS) announced a new voluntary program to expand coverage of GLP-1 drugs for weight loss and diabetes under Medicaid and Medicare Part D plans. This initiative follows a November agreement between the Trump administration, Eli Lilly, and Novo Nordisk to reduce prices for popular GLP-1 therapies.
The program, part of CMS’s BALANCE initiative, aims to standardize coverage terms, negotiate guaranteed net prices, potentially cap out-of-pocket costs, and integrate evidence-based lifestyle support for beneficiaries.
Under the initiative, Medicare patients will pay $50 per month for eligible GLP-1 medications, including Eli Lilly’s Zepbound and Novo Nordisk’s Wegovy. The program will launch for Medicaid as early as May 2026 and for Medicare in January 2027. A short-term Medicare payment demonstration will begin in July 2026, bridging to the full BALANCE model.
CMS Administrator Mehmet Oz stated that the program is intended to increase access to select GLP-1 medications and support healthy lifestyle choices. Participation will be voluntary for manufacturers, states, and plans.
The November price agreement set the cost for Medicare and Medicaid enrollees at $149 per month for new GLP-1 weight-loss medications. Existing injectable GLP-1s for diabetes and other conditions will cost $245 per month under the program.
The initiative is expected to improve access to obesity and diabetes treatments for eligible U.S. patients, while integrating lifestyle interventions alongside medication coverage.
Key Points:
- CMS BALANCE initiative aims to expand GLP-1 coverage under Medicare and Medicaid.
- Eligible beneficiaries pay $50/month for GLP-1 medications.
- Program launches for Medicaid in May 2026, Medicare in January 2027.
- Voluntary participation for manufacturers, states, and plans.
- Focus on combining drug access with evidence-based lifestyle support.
Companies Involved:
- Eli Lilly & Co
- Novo Nordisk A/S
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