Millions of older Americans could soon gain access to popular weight-loss medications at a fraction of their current cost. The Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model program that would allow certain Medicare beneficiaries to obtain GLP-1 drugs for obesity for as little as $50 per month.
Under current law, Medicare is prohibited from covering medications prescribed solely for weight loss. However, both the Trump and Biden administrations have argued that obesity should be treated as a chronic disease and that GLP-1 medications play an important role in preventing serious health conditions such as diabetes, heart disease, and stroke.
The newly announced initiative, known as Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE), is designed to expand access to GLP-1 drugs while keeping costs under control. CMS has negotiated discounted prices with drugmakers Eli Lilly and Novo Nordisk, pairing medication access with lifestyle and nutrition support through Medicare Part D plans.
CMS Administrator Dr. Mehmet Oz said the effort is intended to “democratize access to weight-loss medication” that has previously been out of reach for many Americans. The program aims to combine medical innovation with healthier living strategies in a way that benefits patients while limiting costs for taxpayers.
How the program would work
CMS plans to negotiate both pricing and eligibility standards with drug manufacturers. Under the agreement announced last month, eligible Medicare enrollees would pay $50 per month for certain GLP-1 medications approved for obesity and diabetes, while Medicare would cover an additional $245 per prescription.
Eligibility would be limited. Those who qualify include people who are overweight with prediabetes, individuals who have experienced a stroke or other cardiovascular events, and patients with obesity combined with diabetes or severe, uncontrolled high blood pressure. Officials estimate that roughly 10% of Medicare beneficiaries would meet the criteria.
Participation in the BALANCE model is voluntary for drug manufacturers, state Medicaid programs, and Medicare Part D insurers. State Medicaid agencies can opt in starting in May 2026, with Part D plans following in January 2027. In the meantime, CMS plans to launch a short-term demonstration program that could allow Medicare beneficiaries to access GLP-1 medications as early as July. That temporary program would run through December 2031.
A shift from previous policy debates
Last year, the Biden administration proposed reinterpreting Medicare law to allow obesity drugs to be covered as treatment for a chronic condition, an approach estimated to cost Medicare $25 billion over 10 years. That effort was paused earlier this year. The current plan, by contrast, includes negotiated price reductions, which the Trump administration says will make the expansion cost-neutral.
The agreement also extends to Medicaid. Eli Lilly and Novo Nordisk have committed to offering GLP-1 medications at lower prices to state Medicaid programs, although coverage decisions will depend on individual state negotiations. As of October, 16 state Medicaid programs covered GLP-1 drugs for obesity. However, several states, including North Carolina and Michigan, have recently scaled back coverage due to rising costs.
Industry and insurer reactions
Some insurers are cautiously optimistic. The Alliance of Community Health Plans noted that GLP-1 drugs have been shown to improve health outcomes, but also warned that side effects can cause many patients to discontinue treatment within the first year. The group said it is seeking more clarity on insurer costs and long-term sustainability.
With more than 70% of U.S. adults classified as overweight or obese, CMS argues that expanding access to effective treatments could significantly reduce the burden of chronic disease nationwide. Whether the BALANCE model succeeds may depend on how well it balances affordability, patient adherence, and long-term health outcomes.
Your responses and feedback are welcome!
Source: “Medicare opens door to covering blockbuster drugs for weight loss,” CNN.com, 12/23/25
Source: “US health agency unveils weight-loss drug coverage model,” Reuters, 12/24/25
Image by RDNE Stock project/Pexels
FAQs and Media Requests: 
