By Danial Amjad, Policy Analyst
A Medicare pilot program that aimed to expand access to popular weight loss drugs for seniors has hit a major setback after negotiations with insurers and pharmaceutical companies fell apart.
The program, known as BALANCE, was designed to give certain Medicare beneficiaries access to GLP-1 medications, for a monthly copay of around $50. GLP-1 drugs, which include Ozympic and Wegovy, originally developed to treat diabetes, have become increasingly popular because of their effectiveness in helping patients lose weight and manage obesity-related health conditions.
Under the original plan, private Medicare insurers participating in Medicare Part D would help cover the drugs as part of a broader pilot program scheduled to begin in 2027. However, several major insurers raised concerns about the financial structure of the program, uncertainty around long-term costs, and the potential impact on Medicare drug plans. As a result, the Centers for Medicare & Medicaid Services (CMS) delayed the Medicare portion of the BALANCE program.
Despite the delay, some seniors will still temporarily receive access to these medications through a separate “Medicare GLP-1 Bridge” program beginning in July 2026. The bridge program will run through the end of 2027 and allow eligible Medicare beneficiaries enrolled in qualifying Part D or Medicare Advantage plans to access certain GLP-1 drugs for a $50 copay negotiated by CMS. To qualify, enrollees must obtain prior authorization, plus have a BMI of 35 or higher or meet one of 27 other clinical criteria.
For many seniors, the bridge program may provide temporary financial relief as policymakers continue debating whether Medicare should permanently expand coverage of weight loss medications. At TSCL, we are advocating to increase access to these drugs, especially for seniors struggling with diabetes or cardiovascular disease. Like adding dental, vision, and hearing coverage to Medicare, this could improve long-term health outcomes and lower costs elsewhere in the healthcare system by replacing treatment with prevention.
