CMS extends the Medicare GLP-1 Bridge through December 31, 2027 after BALANCE is delayed in Part D

CMS has extended the Medicare GLP-1 Bridge, its short-term demonstration covering certain weight-loss drugs for Part D beneficiaries, through December 31, 2027 ^[1]. The extension follows CMS's decision not to launch the BALANCE Model in Medicare Part D as originally planned, leaving the Bridge as the only route to Medicare coverage of GLP-1s prescribed solely for weight management ^[2].

The Bridge was originally scheduled to run only from July 1, 2026 through December 31, 2026 ^[2]. CMS announced the BALANCE delay and the Bridge extension on April 21, 2026, according to a KFF timeline of the demonstrations ^[2]. In its provider FAQ, CMS says the extension gives eligible beneficiaries continued access to certain GLP-1 drugs while allowing the agency "to collect additional data on GLP-1 utilization to share with Part D plan sponsors ahead of potential implementation of BALANCE in Part D" ^[1].

What the Bridge covers

The Bridge operates outside the normal Part D coverage and payment flow. Part D sponsors carry no financial risk for drugs furnished through it, and plans do not have to opt in for their members to use it ^[1]. In 2026, CMS uses a single central processor to handle prior authorization, claims and pharmacy payment ^[1]. It was created under Section 402 demonstration authority and is not itself a Part D plan ^[1].

Eligible beneficiaries pay a copayment of $50 per month ^[2]. The eligible drug list, updated April 6, 2026, includes all formulations of Foundayo (orforglipron) and Wegovy (semaglutide injection and tablets), plus only the KwikPen formulation of Zepbound (tirzepatide) ^[1]. Zepbound single-dose vials and single-dose pens are not included ^[1]. Pen needles for the KwikPen are not covered and should not be billed to the Bridge or to a Part D plan ^[1].

To qualify, a prescriber must submit a prior authorization attesting the drug is prescribed to reduce excess body weight and maintain weight reduction alongside ongoing lifestyle changes, and that the patient is at least 18 and met one of three thresholds at the time GLP-1 therapy began: BMI of 35 or higher; BMI of 30 or higher with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above; or BMI of 27 or higher with pre-diabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease ^[1]. The criteria apply at the time therapy started, including for people who began before enrolling in Part D or before the July 1, 2026 launch ^[1].

People whose GLP-1 is prescribed for type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH are not eligible for the Bridge, because those indications are already covered by Part D ^[1]. CMS also says prescriptions written to reduce the risk of major adverse cardiovascular events should be routed to the Part D plan, even if weight reduction is also a goal ^[1].

Eligibility also depends on plan type. Standalone PDPs and Medicare Advantage coordinated care plans with drug coverage qualify, as do Special Needs Plans, employer/union group waiver plans and LI NET ^[1]. Private fee-for-service plans, section 1876 cost contracts, PACE organizations and several other arrangements are excluded unless the person also has a standalone PDP ^[1].

Why it matters for patients

Federal law still bars Medicare from covering drugs used specifically for weight loss ^[2]. The Bridge is a temporary workaround, and its extension means eligible beneficiaries who start in July 2026 have a defined runway through the end of 2027 rather than six months. What happens after December 31, 2027 is not yet decided; CMS describes BALANCE in Part D only as a "potential" future implementation ^[1], and KFF characterizes the delay as indefinite ^[2].

Cost pressure is real for this group. KFF polling found 56% of GLP-1 users said the drugs were difficult to afford, including one in four who said "very difficult" ^[2]. Gross Medicare spending on GLP-1s for already-covered uses reached $27.5 billion across 21.8 million claims in 2024 ^[2].

One process detail matters at the pharmacy counter: CMS says prescribers should send the prescription first and wait for the pharmacy to request prior authorization, because submitting the request too early returns a "patient not found" error ^[1]. A call center for prescribers operates at 855-273-0102, weekdays 8 a.m. to 7 p.m. ET ^[1].

What happens next

Medicaid's version of BALANCE is proceeding, launching on a rolling basis from May 1, 2026 through January 1, 2027, with a July 31, 2026 application deadline for states and an end date of December 31, 2031 ^[2]. Separately, the negotiated Medicare price for semaglutide takes effect in 2027 ^[2]. As of January 2026, 13 states covered GLP-1s for obesity under Medicaid, down from 16 in 2025 ^[2].