The Proposed BALANCE Model Would Expand Access to and Lower Costs of GLP-1 Drugs in Medicare and Medicaid

It's one of several efforts to improve affordability and expand access to GLP-1s. ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­  

The independent source for health policy research, polling, and news. The independent source for health policy research, polling, and news. NEW & NOTEWORTHY KFF Examines the Trump Administration's Proposed BALANCE Model to Expand Access to and Lower Costs of GLP-1 Drugs in Medicare and Medicaid A new KFF analysis examines the BALANCE Model, a recently proposed model under the Center for Medicare and Medicaid Innovation (CMMI), and other Trump administration efforts to improve affordability and expand access to GLP-1 medications in the Medicare and Medicaid programs. Despite the effectiveness of GLP-1 medications—widely used to treat diabetes, obesity, and related conditions— Medicare does not cover drugs used specifically for weight loss, and Medicaid coverage of weight loss drugs remains optional for states. Even with these limitations, gross spending (before rebates) on the costly GLP-1 drugs for uses other than weight loss has surged, reaching $27.5 billion in Medicare and $8.6 billion in Medicaid in 2024. The analysis highlights new time-limited initiatives from the Trump administration aimed at addressing the gaps in access and affordability. A short-term Medicare GLP-1 Bridge demonstration, running from July through December 2026, will offer eligible Medicare beneficiaries access to select medications for obesity at a $50 monthly copayment. This will be followed by the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model, launching in 2026 for Medicaid and in 2027 for Medicare, a voluntary demonstration running for 5 years that seeks to expand coverage of GLP-1s for obesity, negotiate lower drug prices with manufacturers, and provide lifestyle support programs to improve health outcomes. While these initiatives could significantly expand access to weight loss drugs for people with Medicare and Medicaid, uncertainties related to participation and the impact on federal, state, and Medicare beneficiary costs remain. Read the analysis Contact: Chris Lee | 202.654.1403 | ChrisL@kff.org  When citing our work, please note our legal name is KFF. We should be cited as KFF, a nonprofit health policy research, polling, and news organization. Our name is no longer the Kaiser Family Foundation.  Did someone forward this to you? Sign up for emails from KFF. This email was sent to awesomeblogger71.lificletter@blogger.com. Update your email preferences to choose the types of emails you receive. Or, permanently unsubscribe from all future emails. Need assistance? Email subscriptions@kff.org; do not reply to this email. The independent source for health policy research, polling, and news. KFF, 185 Berry Street, Suite 2000, San Francisco, CA 94107