CMMI Introduces New Drug Pricing and Chronic Care Models

Since late December, the Center for Medicare and Medicaid Innovation (CMMI) has announced four new drug pricing and chronic care models: Global Benchmark for Efficient Drug Pricing (GLOBE); Guarding U.S. Medicare Against Rising Drug Costs (GUARD); Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model; and the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model.

The GLOBE and GUARD models are mandatory and will test alternative methods of calculating Part B and Part D inflation rebates, incorporating international reference pricing for specific drug categories rather than the current domestic benchmark. The benchmark would rely on either manufacturer-reported international pricing data or other available information for economically comparable countries. The model will apply to approximately 25% of Medicare beneficiaries and Part D enrollees in the U.S. The GLOBE Model will begin Oct. 1, 2026, and the GUARD Model will begin Jan. 1, 2027. The Cigna Group will communicate its perspectives through our trade association partners.

The voluntary BALANCE model will enable Medicare Part D plans and state Medicaid agencies to cover GLP-1 medications used for weight management and metabolic health issues, while helping control costs for patients and taxpayers. CMS will negotiate directly with pharmaceutical manufacturers of GLP-1 drugs for lower net prices and standardized coverage terms, with eligible Medicare beneficiaries paying $50 per 30-day prescription.

The BALANCE Model will launch in Medicaid as early as May 2026 and in Medicare Part D in Jan. 2027. Relatedly, CMS plans to implement a new Medicare GLP-1 payment demonstration beginning in July 2026, which will serve as a short-term bridge to the BALANCE model. The Cigna Group is engaged with CMMI as further details such as payment and coverage criteria are addressed.

Finally, the ACCESS model is a voluntary ten-year demonstration to shift how Medicare Fee-for-Service (FFS) pays for chronic disease management, integrating technology-supported care, outcome-aligned payments, and new channels for patient enrollment. The ACCESS model is focused on chronic conditions that represent a disproportionate share of Medicare spend and disease burden and will begin July 1, 2026, with rolling admissions beginning Jan. 1, 2026.