Medicare changes coverage for GLP-1 weight loss drugs
USA Today • • business
Key Points:
- Medicare has postponed the BALANCE program, which would have required insurance companies to cover GLP-1 weight-loss drugs like Novo Nordisk's Wegovy and Eli Lilly's Zepbound, due to insurer concerns.
- Instead, Medicare will offer these weight-loss medications through a bridge program from July 1, 2026, to December 31, 2027, allowing enrollees to access drugs at negotiated prices with a $50 monthly copay.
- The BALANCE program will continue for Medicaid, with states able to apply through July 31, 2026, while Medicare's bridge program provides temporary access outside traditional Part D coverage.
- Pharmaceutical companies Lilly and Novo Nordisk support the bridge program and advocate for long-term solutions to ensure seniors' access to GLP-1 weight-loss drugs.
- Analysts note that while the bridge program reduces near-term uncertainty, the indefinite delay in permanent Medicare coverage creates long-term ambiguity, though the obesity benefit is expected to remain politically and practically difficult to reverse after 2028.
