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For beneficiaries to be eligible under the BALANCE Model, providers must attest that they meet certain clinical criteria, including qualifying for a GLP-1 for a currently covered use (such as type 2 diabetes, cardiovascular disease risk reduction, or sleep apnea) or for use to treat obesity based on similar clinical criteria as applied in the Medicare GLP-1 Bridge (Figure 3)
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Recently, newer options have been more successful in individuals with a BMI 30 kg/m 2 or 27 kg/m 2 with obesity-related comorbidities such as type 2 diabetes, high blood pressure, high cholesterol or obstructive sleep apnea