CMS shelves Medicare Part D launch of BALANCE for 2027 and extends GLP-1 Bridge

CMS will not launch the Medicare Part D portion of the BALANCE model in 2027, announcing the change on April 21, 2026 — one day after Part D plan sponsor applications were due — and extending a separate short-term demonstration, the Medicare GLP-1 Bridge, through December 31, 2027 ^[1][4].

BALANCE was designed to test expanded Part D coverage of GLP-1 medications for weight management from January 1, 2027 through December 31, 2031 ^[1][2]. CMS accepted Part D sponsor applications until April 20, 2026, and had said it would tell plans by April 30, 2026 whether it would move forward ^[2]. The model was conditioned on participation by a critical mass of sponsors ^[2]. One coverage guide describes the test as sponsors covering at least 80% of all Part D beneficiaries ^[4], while an industry briefing describes it as 80% of Part D sponsors ^[3].

CMS describes the Part D launch as indefinitely delayed rather than canceled ^[1]. The memo sent to plan sponsors framed the decision as "pending further evaluation and data collection" ^[4]. A coverage guide says the next signal to watch is the CY2028 Advance Notice, typically released in January or February 2027 ^[4]. No 2028 launch date has been confirmed.

The Medicare GLP-1 Bridge, originally scheduled to run from July through December 2026, will now run from July 1, 2026 through December 31, 2027 ^[1][4]. It operates outside regular Part D coverage, is nationwide, and does not require plans to opt in ^[1]. Beneficiaries who qualify pay $50 per month for GLP-1s approved for weight reduction: all formulations of Foundayo (orforglipron) and Wegovy (semaglutide), plus the KwikPen formulation of Zepbound (tirzepatide) ^[1]. Eligibility generally follows BMI: 35 or higher; 30 or higher with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above; or 27 or higher with prediabetes, a prior heart attack, a prior stroke, or symptomatic peripheral artery disease, with provider attestation ^[1][4].

The Medicaid side of BALANCE was not affected ^[1][4]. State Medicaid agencies can apply until July 31, 2026 and start on a rolling basis between May 1, 2026 and January 1, 2027, with the model running through December 31, 2031 ^[1][4]. Only 13 states covered GLP-1s for obesity in Medicaid as of January 2026, down from 16 in 2025 ^[1][3].

On why the Medicare piece stalled, a coverage guide reports that UnitedHealthcare said publicly it was "still working through" whether to participate, and that Bloomberg reporting indicated CVS Health (Aetna) declined ^[4]. Those decisions are described as leaving the 80% threshold out of reach ^[4]. A separate industry briefing, published before the announcement, said most Part D sponsors did not expect the threshold to be met ^[3].

BALANCE's Medicare design would have set cost sharing at $50 a month in enhanced plans and $125 a month in basic plans, with a negotiated net price of $245 per 30-day supply from Novo Nordisk and Eli Lilly for 2027 ^[3].

Why it matters for patients

Medicare Part D enrollees who want a GLP-1 for weight reduction still have a route in 2027, but only through the Bridge, which covers specific formulations and ends December 31, 2027 unless it is extended again ^[1][4]. People who take these drugs for type 2 diabetes, cardiovascular risk reduction, or sleep apnea use regular Part D coverage rather than the Bridge or BALANCE ^[1][4].

For Medicaid, access depends on whether a state joins. Participation is voluntary, and KFF notes states may join for one year and drop out, which could disrupt coverage ^[3]. For 2027 plan comparisons, BALANCE participation is no longer a difference between plans, since no Part D portion is launching that year ^[4].

Cost pressure remains the backdrop. In KFF polling, 56% of GLP-1 users said the drugs were difficult to afford, including one in four who said "very difficult" ^[1]. In 2024, Medicare recorded 21.8 million GLP-1 claims and $27.5 billion in gross spending, and Medicaid recorded 8.4 million prescriptions and $8.6 billion, before rebates ^[1]. CMS documentation does not include estimates of the Bridge's or BALANCE's effects on federal or state budgets ^[3], and KFF wrote there is "little evidence to date" that expanded GLP-1 use is offset by lower spending on other health services in the short term ^[3].

What happens next

• May 1, 2026 to January 1, 2027: BALANCE launches for state Medicaid agencies on a rolling basis ^[1].
• July 1, 2026: Medicare GLP-1 Bridge coverage begins ^[1].
• July 31, 2026: Deadline for state Medicaid agencies to apply to BALANCE ^[1].
• January or February 2027 (expected): CY2028 Advance Notice, described as the next signal on Medicare BALANCE ^[4].
• 2027: The negotiated Medicare price for semaglutide (Ozempic, Wegovy, Rybelsus) takes effect ^[1].
• December 31, 2027: The Medicare GLP-1 Bridge ends as currently scheduled ^[1][4].