In the most recent of a string of announcements ahead of the holiday season, Centers for Medicare & Medicaid Services (CMS) has unveiled a new voluntary access programme which aims to widen the usage of GLP-1 agonist medicines when it comes to diabetes as well as obesity via Medicare and Medicaid.
Notably, the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth – BALANCE scheme is going to enable Medicare Part D plans as well as the state Medicaid agencies to go ahead and cover GLP-1 drugs post negotiating the prices with the federal government.
The announcement comes a few weeks after the Trump administration went on to announce the price discounts to $149 per month when it comes to GLP-1-acting drugs offered by way of Medicare and Medicaid, and also for cash purchasers. That agreement went on to cover semaglutide products for diabetes – Ozempic and weight loss – Wegovy from Novo Nordisk, along with tirzepatide-based rivals Mounjaro as well as Zepbound from Eli Lilly.
The new voluntary access programme – the voluntary BALANCE programme is going to build on that agreement, as per the CMS, which said it anticipates it to begin in May 2026 for Medicaid and January 2027 when it comes to Medicare. It was announced right after the proposals for mandatory drug payment models concerning Medicare Part D as well as Part B.
The negotiations are going to focus on guaranteed pricing, which is $50 per month for Medicare beneficiaries, confirms CMS, in addition to potential price caps, eligibility that’s standardized, coverage along with access, and also mandatory inclusion in terms of lifestyle support programs.
Dr. Mehmet Oz, the CMS administrator, said that BALANCE is going to build on the most favored nation – MFN initiatives by the Trump administration, which include the launch in January 2026 of direct-to-consumer – DTC sales channel TrumpRx and come with the objective of democratizing the access to weight-loss medication, which is apparently out of reach for so many in need.
Additional information is going to be available early 2026, as per CMS, which went on to add that participation is indeed going to be voluntary for manufacturers, states, and health plans; however, the companies interested in the scheme have to submit a notice of intent by January 8, 2026. Apparently, a demonstration of the programme is going to begin in 2026 as a bridge to complete execution.
CMS said it is also going to closely track the impact of the model when it comes to cost, outcomes, and adherence in order to determine if it is offering enhanced health and lower expenses that are associated.
The announcement came right after Novo Nordisk went on to open up a new chapter of the GLP-1 story, having the FDA approval of Wegovy’s pill version, which, by the way, is the first oral drug in its class to be given the go-ahead for weight loss.
