CMS delays Part D portion of BALANCE Model on expansion of GLP-1 access

The Centers for Medicare & Medicaid Services announced in a memo April 21that it is delaying implementation of the Medicare Part D portion of the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth Model, or BALANCE, for 2027 pending further evaluation and data collection. The model is intended to increase access to glucagon-like peptide-1 (GLP-1) medications - used for weight loss and other health needs - and other healthy lifestyle interventions. CMS said that Part D beneficiaries would still have access to certain GLP-1 medications through the Medicare GLP-1 Bridge, which is being extended through Dec. 31, 2027.

CMS will still accept applications for the BALANCE Model from state Medicaid agencies through July 31, 2026. The agency said that states can choose to begin model participation on a date of their choosing between May 1, 2026, and Jan. 1, 2027. States that do not join the model by Jan. 1, 2027, will only be allowed to participate at CMS' discretion. The agency said it will provide additional information regarding updates to the BALANCE Model.