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FOR IMMEDIATE RELEASE
December 23, 2025
Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
CMS Launches Voluntary Model to Expand Access to Life-Changing Medicines, Promote Healthier Living
Model test enables state Medicaid agencies, Medicare Part D sponsors to cover GLP-1 drugs while controlling costs
The Centers for Medicare & Medicaid Services (CMS) announced today a new voluntary test of a model that is designed to enable Medicare Part D plans and state Medicaid agencies to cover GLP-1 medications used for weight management and metabolic health improvement, while helping control costs for patients and taxpayers.
The Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model builds on emerging evidence that combines access to GLP-1 medications with access to evidence-based lifestyle supports to achieve better long-term health outcomes. The model represents a major step toward potential expanded access and affordability for millions of Americans.
“Today’s announcement builds upon our historic Most Favored Nations drug pricing deals’ goal of democratizing access to weight-loss medication, which has been out of reach for so many in need,” said CMS Administrator Dr. Mehmet Oz. “These actions further the administration’s bold plan to reform our country’s health systems and Make America Healthy Again. With the BALANCE Model, we’re pairing breakthrough science with healthy living to cut costs while empowering Americans to take control of their health.”
Under the model, CMS negotiates directly with pharmaceutical manufacturers of GLP-1 drugs 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 BALANCE Model will empower more Americans to live healthier lives by expanding access to GLP-1s that have shown to be a powerful tool against the development of diseases, such as diabetes, cardiovascular disease, and other metabolic conditions, which can negatively affect a person’s long-term health,” CMS Innovation Center Director Abe Sutton said. “Through this model, CMS will make GLP-1s more accessible for people with Medicare and Medicaid.”
Participation will be voluntary for manufacturers, states, and plans. Additional information will be released in early 2026 regarding state and Part D plan participation. The BALANCE Model will launch in Medicaid as early as May 2026 and in Medicare Part D in January 2027.
CMS has issued a Request for Applications to manufacturers, which are due January 8, 2026. Additionally, CMS has issued notices of intent for state Medicaid agencies and Medicare Part D plans, which are also due January 8, 2026.
The CMS Innovation Center will rigorously evaluate the model’s impact on costs, adherence, outcomes, and beneficiary experience to determine whether it improves health and generates savings.
To learn more about the BALANCE Model, visit: https://www.cms.gov/priorities/innovation/innovation-models/balance.
Prior to the launch of the BALANCE model, CMS also plans to implement a new Medicare GLP-1 payment demonstration beginning in July 2026, which will serve as a short-term bridge to the model. This additional payment demonstration means that Medicare beneficiaries can start accessing these important medications at prices negotiated by the Administration as soon as possible.
The GLP-1 payment demonstration will operate outside of the Medicare Part D benefit’s coverage and payment flow, which means that Part D Plan Sponsors will not carry risk for eligible GLP-1 products furnished under the demonstration. Beneficiaries enrolled in Medicare Part D who meet the negotiated access criteria will have access to these drugs. Under the demonstration eligible Medicare beneficiaries will pay $50 for a month of GLP-1 medications.
CMS will provide additional information on the design and implementation of the GLP-1 payment demonstration in early 2026.
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