CMS is holding off on its voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model pilot for Medicare Part D, the agency confirmed to Becker’s April 21.
Under BALANCE, CMS would negotiate lower GLP-1 prices for Medicaid programs and Medicare Part D plans. The program would also feature lifestyle-oriented initiatives. Part D plan sponsors had until April 20 to apply.
CMS could only progress with the Medicare portion in 2027 if it met a critical mass threshold: Part D plan sponsors representing 80% of Part D enrollment had to apply. The Medicaid portion of the pilot will still move forward, and state Medicaid programs can apply through July 31.
The same day CMS shared the Medicare update, UnitedHealthcare’s CEO of government programs, Bobby Hunter, said the insurer is hoping “to find a path to ‘yes'” with BALANCE participation, “but there are some notable challenges and outstanding questions with the currently planned structure.”
He said UnitedHealthcare would partake in the Medicare GLP-1 Bridge demo that begins in July. Based on stakeholder feedback, CMS said it modified the demo to run through Dec. 31, 2027.
Since the model’s announcement in December, questions regarding the pilot have remained, specifically regarding implementation, adherence and regulatory issues, a March KFF analysis found. Bloomberg News reported April 21 that Aetna’s parent company, CVS Health, said the insurer would not participate.
CMS said it will share next steps when available.
Becker’s contacted Aetna and will update this story if more information becomes available.
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