Eli Lilly (LLY) and CMS Expand Medicare Access to Zepbound and Mounjaro

Eli Lilly and Company (NYSE:LLY) is one of the best stocks for 20 years. On March 9, Eli Lilly released an updated statement following new implementation details from the Centers for Medicare and Medicaid Services regarding the CMMI BALANCE Model. This program marks a major expansion in patient access to tirzepatide medications, specifically Zepbound and Mounjaro, as well as the investigational drug orforglipron. Starting January 1, 2027, these treatments will be available through participating Medicare Part D plans, with out-of-pocket costs for most beneficiaries capped at $50 per month after the deductible is met.

To bridge the gap until the full program begins, Eli Lilly highlighted the Medicare GLP-1 Bridge Model, which will take effect from July 1 through the end of that year. During this initial six-month period, eligible Medicare Part D beneficiaries can access these medications for no more than $50 per month with no deductible. For the subsequent 2027 rollout, even before patients meet their deductibles, cost-sharing will be limited to $245 per month plus a dispensing fee, providing immediate financial relief compared to traditional pricing structures.

Eli Lilly and Company (NYSE:LLY) is currently working with health plans and providers to educate patients on their specific plan options, as a small number of basic Medicare Part D plans may have varying cost-sharing requirements. Additionally, state Medicaid programs have been invited to apply for participation starting May 1 on a rolling basis.

Eli Lilly and Company (NYSE:LLY) discovers, develops, manufactures, and markets human pharmaceutical products in the US, Europe, China, Japan, and internationally.

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