CMS Extends Medicare's Short-Term Bridge Program for GLP-1 Obesity Drug Coverage

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By Juliette Cubanski and KFF Health News HealthDay Reporters

Medically reviewed by Carmen Pope, Senior Medical Editor, B. Pharm. Last updated on April 27, 2026.

via HealthDay

The Centers for Medicare & Medicaid Services (CMS) has announced that its temporary program to cover GLP-1 drugs for obesity in Medicare, called the BALANCE model, will not launch as scheduled on Jan. 1, 2027.

Instead, CMS is extending the duration of a separate program, called the Medicare GLP-1 Bridge, which had been scheduled to run from July to December 2026. It will now run through the end of 2027.

Under the Bridge program, eligible beneficiaries can get Medicare coverage of GLP-1s for obesity for a $50 copay.

Extending the short-term GLP-1 Bridge program is good news for eligible Medicare beneficiaries, because it provides the certainty of obesity drug coverage at a $50 copay for a longer period.

But federal spending will rise an unknown amount since CMS hasn’t disclosed the projected cost.

The cost to Medicare of covering obesity drugs under Part D has been estimated at between billion and billion over 10 years. This could have been a driving factor in the reluctance or unwillingness of major Part D plan sponsors to participate as the BALANCE model was originally designed.

While CMS sought robust participation of Part D plan sponsors in the BALANCE model, which was voluntary for plans, interest appears to have fallen short of the targeted level.

Although GLP-1 drug manufacturers agreed to a $245 net price, a substantial discount from prevailing list prices, savings to plans from a lower price may not have offset higher costs associated with an uptake in GLP-1 use for obesity treatment.

Plans would also have been at some financial risk if their actual costs for covering GLP-1s were higher than expected. Higher costs for Part D plans under the BALANCE model would have translated to higher federal spending and increased Part D premiums for enrollees, always a tough sell but especially so when the cost of health care, including prescription drugs, ranks as a top concern for many Americans.

Implementation of the BALANCE model in Medicare faces an uncertain future. CMS could choose to revise the financial incentives to make participation more appealing to Part D plan sponsors, such as by negotiating an even lower net price with manufacturers or taking other steps to shift financial risk associated with GLP-1 coverage away from plans.

While CMS’s approach to Medicare obesity drug coverage after the short-term program ends is unknown, a financially sustainable solution for how to cover GLP-1 drugs for obesity remains elusive.

Sources

  • KFF Health News, April 23, 2026

    • Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

    Source: HealthDay

    Posted : 2026-04-28 02:13

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