Centers for Medicare & Medicaid Services

Federal agency managing $1 trillion annually covering Medicare, Medicaid, CHIP, and ACA marketplaces for 145 million Americans. - Administering BALANCE model to expand GLP-1 access

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

Federal agency whose reimbursement decisions determine whether blood tests become economically viable. - Determining reimbursement rates for blood tests

For decades, diagnosing Alzheimer's meant either a $5,000 brain scan with radiation exposure or a painful spinal tap. In October 2025, the FDA cleared Roche's blood test for use in primary care—a simple blood draw that rules out Alzheimer's 97.9% of the time. It's the second blood test approved in five months, transforming a diagnosis that once required specialists and imaging centers into something your family doctor can order.

Updated Jan 9

CMS is being used to translate “CBD research” into a tangible benefits experiment for seniors. - Linked to a new CBD access pilot described alongside the executive order

Trump’s executive order instructing DOJ to fast-track marijuana’s move to Schedule III immediately triggered a familiar split-screen: public health and industry groups cheered the potential research and tax impacts, while House Republicans organized opposition, urging Trump to keep marijuana in Schedule I.

Updated Dec 18, 2025