Insurance Industry Organization
Appears in 1 story
Cautiously supportive of BALANCE, seeking cost details
Medicare has been banned from covering weight loss drugs since 2003. CMS launched the BALANCE voluntary model in December 2025 to work around the law—negotiating $50-per-month access to Ozempic, Wegovy, and similar blockbusters for 10% of Medicare enrollees starting July 2026. The workaround: don't call it weight loss coverage, call it treatment for chronic disease with specific comorbidities. Manufacturer applications closed January 8, 2026, with negotiations continuing through February 28.
Updated Jan 14
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