Medicare GLP‑1 pilot shelved

The Trump administration has shelved a Medicare pilot that was supposed to open weight-loss drug coverage to older Americans this summer. (axios.com) Federal officials told Axios on April 22 that the delay was indefinite after insurers raised concerns about participating in the program. The pilot was tied to Medicare coverage of glucagon-like peptide-1 drugs, or GLP-1s, such as Wegovy and Zepbound. (axios.com) GLP-1 drugs mimic a gut hormone that helps people feel full and lowers blood sugar. Medicare generally does not cover drugs prescribed only for weight loss, which is why the Centers for Medicare & Medicaid Services built a separate demonstration outside the standard Part D benefit. (cms.gov) (kff.org) CMS had said the short-term “Medicare GLP-1 Bridge” would run from July 1, 2026, through December 31, 2027, while a broader BALANCE model was set to start in Medicare Part D in January 2027. CMS also said the bridge would operate outside Part D’s normal coverage and payment flow. (cms.gov 1) (cms.gov 2) The administration had pitched BALANCE in December 2025 as a voluntary model that would let Medicare Part D plans and state Medicaid agencies cover GLP-1s while CMS negotiated prices and coverage terms with drugmakers. CMS said at the time that manufacturers, states and plans would all choose whether to participate. (cms.gov) That left the rollout dependent on private insurers even before this week’s reversal. CMS said in March that Part D plan sponsors were being encouraged to apply, and Axios reported insurers later balked at joining. (cms.gov) (axios.com) Private coverage has been moving slowly too. An International Foundation of Employee Benefit Plans survey found the share of employers covering GLP-1 drugs for both diabetes and weight loss rose to 36% from 34% a year earlier. (blog.ifebp.org) KFF’s 2025 employer health benefits survey found bigger companies were more likely to cover GLP-1s for weight loss, but employers told KFF they were also weighing cutbacks, tighter rules and other cost controls because of spending pressure. (kff.org 1) (kff.org 2) Before the delay, KFF said people who qualified for the Medicare bridge would have paid a $50 copayment for Wegovy or Zepbound, and that payment would not have counted toward Part D’s deductible or annual out-of-pocket cap. KFF also noted that low-income subsidies would not have applied to bridge prescriptions. (kff.org) For now, the federal path to broader Medicare obesity-drug coverage is narrower than CMS described in March. Access is still expanding in pieces — through some employers, some private programs and retail channels — but not through the Medicare pilot the administration had planned for July 1. (cms.gov) (axios.com)