UnitedHealth Faces Challenges in BALANCE Model Participation

Asked on UnitedHealth's (UNH) earnings call about the company's plans to participate in the BALANCE Model for GLP-1s and its anticipation of whether the industry thresholds for participation will be met, Bobby Hunter, UnitedHealth's chief of government programs, stated in part: "As it relates to your question about the BALANCE Model, we've been in good active dialogue with both CMS and CMMI on that front. We'd like to find a path to yes there on coverage over time, but there are some notable challenges and outstanding questions with the currently planned structure. We're still working through that process internally, and we look forward to continuing the dialogue with CMS. We've provided some specific recommendations that we believe would serve all stakeholders really well." Medicare insurers had until April 20 to tell the government whether they would participate in the plan to add coverage for weight-loss drugs from Eli Lilly (LLY) and Novo Nordisk (NVO) in 2027 and if the Centers for Medicare and Medicaid Services doesn't get most insurers to sign up, the program can't go forward, the agency has said. Shares of Eli Lilly and Novo Nordisk are trading lower on Tuesday morning by 3% and 2%, respectively.