Understanding the BALANCE Model for GLP-1 Medications in Medicare and Medicaid - Takeaways - MDSpire

Understanding the BALANCE Model for GLP-1 Medications in Medicare and Medicaid

  • By

  • Meredith Freed

  • Juliette Cubanski

  • Elizabeth Williams

  • April 22, 2026

  • 0 min

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  • 1

    CMS announced the BALANCE Model will not be implemented in Medicare Part D in 2027, extending the GLP-1 Bridge program instead.

  • 2

    GLP-1 medications are effective for treating obesity and other conditions but often lack insurance coverage, making them unaffordable for many.

  • 3

    Medicare is legally prohibited from covering obesity drugs, while Medicaid allows states to decide on coverage for weight loss medications.

  • 4

    CMS plans to temporarily expand GLP-1 coverage for obesity in Medicare through the GLP-1 Bridge starting July 2026, prior to the BALANCE Model.

  • 5

    Eligible Medicare beneficiaries will pay a $50 copayment for select GLP-1s under the GLP-1 Bridge, with manufacturers providing drugs at a negotiated price.

Original Source(s)

Understanding the BALANCE Model for GLP-1 Medications in Medicare and Medicaid

  • by Meredith Freed, Juliette Cubanski, Elizabeth Williams

  • April 22, 2026

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