Starting in 2027, participating Medicare Part D plans may begin covering weight-loss medications under CMS’ voluntary BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) model. The announcement follows federal negotiations aimed at securing more favorable pricing for obesity and diabetes treatments.
Recent data analysis from KFF, based on CMS data from 2019–2024, shows a dramatic rise in GLP-1 medication use and spending among Medicare beneficiaries. Use of Ozempic grew from fewer than 150,000 Part D enrollees in 2019 to 2 million in 2024, while Mounjaro climbed to nearly 1 million users in 2024 following its 2022 approval for Type 2 diabetes.
Over that same period, Medicare Part D gross spending on GLP-1 drugs increased fivefold, and total claims rose fourfold. However, estimated rebates of roughly 50% suggest net spending may be lower than gross figures indicate.
As Medicare coverage expands and utilization continues to surge, practices should stay informed about potential cost, prescribing, and reimbursement impacts.