Dec 23 (Reuters) - The U.S. Centers for Medicare and Medicaid Services on Tuesday unveiled a voluntary program to cover GLP-1 drugs for weight-loss and diabetes under Medicaid and Medicare Part D plans,
following the Trump administration's price-cut deal.
U.S. President Donald Trump, Eli Lilly and Novo Nordisk signed a deal in November to slash the prices of popular GLP-1 weight‑loss drugs for the government's Medicare and Medicaid programs, as well as for cash payers.
The new CMS program - which will be launched for Medicaid as early as May 2026 and for Medicare in January 2027 - builds on that agreement, the agency said.
Under its BALANCE initiative, CMS will set standardized coverage terms by directly negotiating guaranteed net prices, potentially capping out-of-pocket costs and bundling evidence-based lifestyle support.
CMS said eligible Medicare beneficiaries will pay $50 for a month's supply of GLP-1 drugs, including Novo and Lilly's injectable obesity medicines, Wegovy and Zepbound.
The agency said it will roll out a Medicare GLP-1 payment demo in July 2026 as a short-term bridge to the BALANCE model, letting beneficiaries access the drugs at administration-negotiated prices.
The program "aims to increase access to select GLP-1 medications and support for healthy lifestyle choices", said CMS administrator Mehmet Oz in a post on X.
Participation in the program will be voluntary for manufacturers, states and plans, according to CMS.
In November's deal, the Trump administration said the doses of highly anticipated weight‑loss pills being developed by Lilly and Novo will cost $149 per month to the government for its Medicare and Medicaid enrollees and to cash payers.
Novo's obesity pill won approval on Monday, while Lilly's version remains under review.
For currently available injectable GLP-1s used for diabetes and other covered health issues, prices to the government would fall to $245 per month for patients in Medicare and Medicaid, the administration said.
(Reporting by Christy Santhosh in Bengaluru; Editing by Shinjini Ganguli and Patrick Wingrove)
