Understanding the BALANCE Model for GLP-1s in Medicare and Medicaid
This editorial outlines the current status of GLP-1 coverage in Medicare and Medicaid, highlighting CMS's initiatives aimed at improving access and reducing costs through the BALANCE model.
The BALANCE model represents a significant effort by the Centers for Medicare & Medicaid Services (CMS) to enhance the accessibility of GLP-1 medications for beneficiaries.
Currently, GLP-1s are covered under Medicare and Medicaid, but there are ongoing initiatives to expand this coverage and make these treatments more affordable.
CMS is exploring temporary demonstration programs, including the BALANCE model, to achieve these goals and improve health outcomes for patients relying on GLP-1 therapies.
Updates
Update at 19:55 UTC on 2026-04-22
KFF reported This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE.
Sources: KFF