New Medicare Model Cuts Costs for GLP-1 Weight-Loss Drugs by 90%
A new government programme aims to make weight-loss medications more affordable for millions of Americans. The initiative, called the BALANCE Model, was launched by the Centers for Medicare and Medicaid Services (CMS) to improve access to certain GLP-1 drugs. With many people struggling to cover the high costs of these treatments, the five-year project could change how such medications are provided.
The move comes as weight loss remains a top priority for many. In 2025, 15% of Americans who made New Year’s resolutions vowed to shed pounds—while nearly a third of Baby Boomers considered using prescription drugs to meet their goals.
The BALANCE Model will run until December 2031 as a voluntary demonstration. Unlike standard programmes, it operates outside existing legal limits, allowing CMS to bypass coverage restrictions on specific medications. Officials will negotiate directly with drug manufacturers to cut costs, set monthly payment caps, and create uniform eligibility rules.
Under the plan, qualifying patients will pay no more than £40 (about $50) per month for GLP-1 medications. To take part, they must meet set criteria and join evidence-based lifestyle support programmes. The model targets four major obstacles: high prices, regulatory bans, inconsistent insurance formularies, and patients stopping treatment due to cost or access issues. State Medicaid agencies can opt into the programme from May 2026. Medicare Part D plans will follow in January 2027. The phased rollout gives providers and patients time to adjust before full implementation.
The BALANCE Model could lower financial barriers for those seeking GLP-1 treatments. By capping out-of-pocket costs and standardising coverage, CMS hopes to keep more patients on their prescribed regimens. The programme’s success may also influence future policies on medication affordability and access.
