{"id":25960,"date":"2026-05-12T09:58:38","date_gmt":"2026-05-12T13:58:38","guid":{"rendered":"https:\/\/medicarereport.org\/?p=25960"},"modified":"2026-05-12T09:58:39","modified_gmt":"2026-05-12T13:58:39","slug":"what-to-know-about-the-balance-model-for-glp-1s-in-medicare-and-medicaid-and-the-medicare-glp-1-bridge","status":"publish","type":"post","link":"https:\/\/medicarereport.org\/?p=25960","title":{"rendered":"What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge"},"content":{"rendered":"\n

(Authors: Meredith Freed, Juliette Cubanski, and Elizabeth Williams for The Kaiser Family Foundation Published: May 11, 2026)<\/p>\n\n\n\n

GLP-1s, a class of drugs used to treat type 2 diabetes, obesity, cardiovascular disease, and other conditions, have exploded in popularity in recent years due to their demonstrated effectiveness, but are often not covered by insurance, particularly for the treatment of obesity. According to KFF polling, about half (56%) of GLP-1 users say these drugs were difficult to afford, including one in four who say they were \u201cvery difficult\u201d to afford. The Trump administration is pursuing various approaches to lowering the cost and expanding coverage of these medications. These approaches include striking \u201cmost-favored nation\u201d deals with GLP-1 manufacturers Novo Nordisk and Eli Lilly, providing access to discounted prices for GLP-1s through TrumpRx, and proposing to implement a new demonstration program called the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model to expand Medicare and Medicaid coverage of GLPs for obesity, which is currently subject to statutory limitations (prohibited in Medicare, permissible but not required in Medicaid). In addition, the GLP-1 drug semaglutide (branded as Ozempic, Wegovy, and Rybelsus) was selected for Medicare drug price negotiation in 2025, with a negotiated price set to take effect in 2027. Continue reading here…<\/a><\/p>\n\n\n\n

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Notice:<\/strong>\u00a0The link provided above connects readers to the full content of the posted article. The URL (internet address) for this link is valid on the posted date; medicarereport.org cannot guarantee the duration of the link\u2019s validity. Also, the opinions expressed in these postings are the viewpoints of the original source and are not explicitly endorsed by AMAC, Inc.; the AMAC Foundation, Inc.; or medicarereport.org.<\/p>\n","protected":false},"excerpt":{"rendered":"

(Authors: Meredith Freed, Juliette Cubanski, and Elizabeth Williams for The Kaiser Family Foundation Published: May 11, 2026) GLP-1s, a class<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[32,21,16,6,15],"tags":[80,1468,238,67,61,65],"class_list":["post-25960","post","type-post","status-publish","format-standard","hentry","category-cms","category-health-care-finance","category-medicaid","category-medicare-general","category-part-dprescription-drugs","tag-cms","tag-glp-1-drugs","tag-healthcare-finance","tag-medicaid","tag-medicare","tag-medicare-part-d"],"_links":{"self":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts\/25960","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25960"}],"version-history":[{"count":1,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts\/25960\/revisions"}],"predecessor-version":[{"id":25961,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts\/25960\/revisions\/25961"}],"wp:attachment":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25960"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25960"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25960"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}