Medicare GLP‑1 pilot shelved

The Trump administration has put off the Medicare Part D piece of its GLP-1 coverage experiment, stopping a broader Medicare expansion for obesity drugs from moving ahead in 2027. (aha.org) The Centers for Medicare & Medicaid Services said in an April 21 memo that it is delaying the Medicare Part D portion of the BALANCE Model for calendar year 2027 while it does more evaluation and collects more data. The American Hospital Association reported the change on April 22. (aha.org) BALANCE, short for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth, was announced on December 23, 2025 as a voluntary model for Medicare Part D plans and state Medicaid agencies. CMS said then that Medicaid could start as early as May 2026 and Medicare Part D in January 2027. (cms.gov) GLP-1 drugs are medicines such as Wegovy and Zepbound that can help with weight loss and metabolic health, but CMS has said they are expensive and that Medicare and Medicaid generally do not cover them when they are prescribed for weight loss. BALANCE was designed to have CMS negotiate prices and coverage terms with manufacturers on behalf of plans and states. (cms.gov) CMS is still keeping a separate short-term program alive. Its “Medicare GLP-1 Bridge” is scheduled to begin July 1, 2026 and now runs through December 31, 2027, giving eligible Medicare Part D beneficiaries access to certain GLP-1 drugs outside the normal Part D payment system. (cms.gov, aha.org) That bridge matters because Part D sponsors do not have to opt in and do not carry the insurance risk for those drugs under the demonstration. CMS says it will use a single central processor in 2026 to handle prior authorization, claims adjudication, and pharmacy payment. (cms.gov) The policy shift changes the message from the White House and CMS earlier this year, when officials were still encouraging Medicare Part D plan sponsors to apply to BALANCE. On March 9, 2026, CMS said Part D sponsors were “encouraged to apply” to a model that would lower costs and expand coverage of select GLP-1 drugs for weight management. (cms.gov) News reports on April 22 said insurer resistance helped force the change. Reuters reported that health insurers were hesitant to participate, and Axios reported the administration was indefinitely delaying the pilot after insurers raised concerns. (usnews.com, axios.com) The immediate result is narrower than the original December rollout: Medicaid can still move through the BALANCE pathway, and Medicare beneficiaries may still get drugs through the bridge, but the planned Part D model launch in 2027 is no longer on the calendar. For now, Medicare’s broader obesity-drug expansion remains delayed while CMS decides whether to revive BALANCE later. (cms.gov, cms.gov, aha.org)