Drug prices & Part D
Medicare Part D Has No Announced Successor for GLP-1 Coverage Once the Bridge Program Closes at End of 2027
CMS has said the BALANCE Model will not launch in Medicare drug plans in 2027, leaving the 50-dollar-copay bridge as the only Part D GLP-1 pathway, now extended through December 2027.
By the Goodsurance editorial teamJuly 18, 2026
Correction, October 12, 2026: We first said type 2 diabetes or high blood pressure can help you qualify. That was wrong. People with type 2 diabetes cannot use the bridge. High blood pressure counts only if it is hard to control and your BMI is 30 or more. We also fixed the dates for states to join the Medicaid part of BALANCE: May 2026 to January 1, 2027. And we took out details on the Part D delay that CMS has not confirmed.
When CMS launched the Medicare GLP-1 Bridge on July 1, 2026, the program was designed as a six-month transition to a permanent model called BALANCE. CMS has since said the BALANCE Model will not launch in Medicare Part D in 2027. CMS has not said when, or if, the Part D part of BALANCE will start.
Medicare's GLP-1 bridge runs through 2027. There is no announced successor plan for what happens next in Medicare drug coverage.
To preserve access, CMS extended the bridge from six months to 18 months, running through December 31, 2027. Under the bridge, eligible Part D enrollees can get qualifying GLP-1 medications for a flat copay if they meet clinical criteria. They qualify with a body mass index (BMI) of 35 or higher; a BMI of 30 or higher with heart failure with preserved ejection fraction, hard to control high blood pressure, or chronic kidney disease stage 3a or higher; or a BMI of 27 or higher with prediabetes, a past heart attack or stroke, or peripheral artery disease with symptoms. People with type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease are not eligible for the bridge, and neither are people who already get a GLP-1 covered by their Part D plan.
CMS has not announced a replacement model for Medicare Part D after December 2027. The Medicaid component of BALANCE is moving forward separately: state Medicaid agencies can join from May 2026 through January 1, 2027, and eligible Medicaid enrollees in participating states gain access as early as May 2026.
Medicare Rights Center has noted the uncertainty this creates for beneficiaries who start GLP-1 therapy under the bridge and may face a coverage gap after 2027 if no follow-on model is announced. CMS has said it will use data gathered during the bridge to inform future Part D planning.
In plain words
Correction, October 12, 2026: An earlier version got the rules wrong. People with type 2 diabetes cannot use the bridge. High blood pressure counts only if it is hard to control and your BMI is 30 or more.
Medicare started covering GLP-1 weight-loss drugs for qualifying members on July 1, 2026. People pay a flat copay. This access runs through December 2027. A bigger permanent program was supposed to take over. It will not start in Medicare in 2027, and CMS has not said when it might. Right now there is no plan for what happens after the bridge ends in late 2027. A related program for Medicaid, the low-income health program, is still going forward in some states.
Understand the basics first
Source: CMS Innovation Center
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