Indiana Gov. Mike Braun directed the state to partake in CMS’ “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model for GLP-1 access in Medicaid.
According to a July 30 Indiana news release, under the pilot, GLP-1s will cost the state $85.16 per member per month. Through BALANCE’s negotiations with Eli Lilly and Novo Nordisk, select GLP-1 medications will be available to the Medicaid program for $245 per member per month, but the federal government will also cover a share.
The state will not incur any costs for the corresponding lifestyle support program run by manufacturers.
“Indiana is proud to expand access to essential treatment for eligible Hoosiers,” Mr. Braun said. “This agreement reflects our commitment to Make Indiana Healthy Again by pursuing practical solutions that increase healthier lives.”
States in the Medicaid drug rebate program have until July 31 to indicate interest in BALANCE. State agreements should be executed with CMS by Jan. 1, 2027.
CMS is currently holding off on its BALANCE pilot for Medicare Part D as the model required a critical mass of plan sponsors to engage. Instead, CMS is focusing on its Medicare GLP-1 Bridge program.
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