Supply Chain
Lilly expands affordable access to diabetes & obesity medicines under new medicare programme
Starting January 1, 2027, Lilly’s Zepbound (tirzepatide), Mounjaro (tirzepatide), and orforglipron, if approved, will be available through participating Medicare Part D plans
- By IPP Bureau
| March 10, 2026
Global healthcare major Eli Lilly’s Centers for Medicare and Medicaid Services (CMS) has unveiled new implementation details for the Medicare and Medicaid CMMI BALANCE Model—a major milestone in Lilly’s pledge to broaden patient access and lower medication costs.
Starting January 1, 2027, Lilly’s Zepbound (tirzepatide), Mounjaro (tirzepatide), and orforglipron, if approved, will be available through participating Medicare Part D plans.
“Most beneficiaries will have out-of-pocket costs capped at $50 per month after the deductible is met,” Lilly confirmed. Before reaching their deductible, patients’ cost sharing will be limited to $245 per month plus a dispensing fee. State Medicaid programs can apply to participate beginning May 1, 2026, with a rolling start.
While most Medicare options will honor the $50 cap, cost sharing may vary in a small number of basic Part D plans. Lilly said it will “actively [educate] patients and their physicians about plan options and smoothing programs that can help patients access medications at the lowest possible out-of-pocket costs.”
The CMMI BALANCE Model builds on the Medicare GLP-1 Bridge Model, which already allows beneficiaries to access Zepbound and orforglipron at no more than $50 per month with no deductible from July 1, 2026, through December 31, 2026.
Lilly reiterated its commitment to broadening access: “We will continue working with CMS, health plans, providers, and pharmacists to extend that access and affordability to every Medicare patient who needs these medicines.”
