JAMA discusses the CMS BALANCE model as a standardized coverage and incentive approach that could reduce prior authorization and lower semaglutide costs, but notes uncertainty about participation and persistence.
At a $245/month price, the CMS BALANCE model could save Medicare nearly $933 million on #semaglutide in 2027, offsetting costs for up to 550 000 additional beneficiaries eligible for #obesity coverage.
Viewpoint: Standardized coverage and incentives in the CMS BALANCE model may reduce prior authorization burden and financial barriers for novel #obesity medications, but broad program participation and persistence remain uncertain.
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