Medicare Begins Covering GLP-1 Obesity Medications; CMS Launches BALANCE Model with $50 Copay Cap

Beginning in April 2026, Medicare began covering GLP-1 receptor agonist medications (such as semaglutide) for beneficiaries with obesity and qualifying comorbidities under the new BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model launched by CMS. Injectable GLP-1 medications are priced at approximately $245/month with patient copays capped at $50. State Medicaid agencies may join the BALANCE model beginning May 2026 through January 1, 2027; Medicare Part D joins in January 2027. All BALANCE model participants receive a lifestyle support program from the manufacturer at no cost. Separately, researchers at the cutting edge are developing a next-generation experimental drug targeting GIP and glucagon receptors that may achieve comparable weight loss without nausea side effects.