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Key Takeaways Prescribers and pharmacies will submit prior authorization requests and claims to a CMS contractor, not Part D plans or their PBMs Detailed conditions for beneficiary eligibility specified Patients will have a copay of $50, but pharmacy reimbursement details remain to be specified Background on the BALANCE Model CMS announced the BALANCE Model in December of last year, in which CMS will negotiate directly with manufacturers on behalf of Part D plan sponsors and state Medicaid agencies for more favorable costs and terms for GLP-1 medications

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GLP-1s reduce cardiovascular disease risk by improving lipids, cholesterol ratios, and inflammatory markers

That is one reason LiPo battery specifications can look more impressive on the wrapper than they feel in real driving or flying