Summary
The Centers for Medicare & Medicaid Services (CMS) announced changes to improve access to certain weight-loss drugs for people using Medicare or Medicaid. A new program called BALANCE will allow these plans to cover GLP-1 medications by negotiating lower prices with drug manufacturers. This aims to make the drugs more affordable and accessible to eligible Americans.
Key Facts
- The changes aim to increase access to GLP-1 weight-loss drugs for Medicare and Medicaid users.
- GLP-1 drugs include medicines like semaglutide (sold as Wegovy, Ozempic) and liraglutide.
- More than 70% of U.S. adults are considered overweight or obese, leading to health problems like diabetes and heart disease.
- The BALANCE program will start in Medicaid in May 2026 and in Medicare Part D in January 2027.
- CMS will negotiate with drug manufacturers for lower prices and uniform terms.
- Participation in BALANCE is voluntary for drug makers, Medicaid agencies, and Medicare plans.
- A temporary payment program will begin in July 2026, with a $50 monthly charge for eligible Medicare users.
