CMS extends Medicare GLP-1 Bridge through 2027 as BALANCE model stalls
The extension keeps a $50 monthly copay path to weight-loss GLP-1s open for eligible Medicare Part D beneficiaries through 2027, though the program's clinical criteria and drug list are unchanged.
CMS has extended the Medicare GLP-1 Bridge through December 31, 2027, keeping a temporary program that pays for certain GLP-1 weight-loss drugs for eligible Medicare beneficiaries running an extra year after the BALANCE model was indefinitely delayed in Medicare Part D [1][2].
The Bridge was originally set to run from July 1, 2026, to December 31, 2026 [2]. CMS says the extension is meant to keep eligible Part D beneficiaries covered and to collect additional data on GLP-1 use that it will share with Part D plan sponsors "ahead of potential implementation of BALANCE in Part D" [1]. CMS announced the indefinite delay of BALANCE in Medicare Part D on April 21, 2026 [2]. A reason for that delay has not been disclosed [1][2].
Which drugs, and what they cost
Covered products are Foundayo (orforglipron), Wegovy (injection and tablets), and Zepbound — but only the KwikPen formulation. The single-dose vial and single-dose pen versions of Zepbound are not included [1]. Pen needles are not covered and should not be billed to the program or to a Part D plan [1]. The beneficiary copay is $50 per month [1][2].
The Bridge runs outside the normal Part D benefit. Part D sponsors do not have to opt in and do not carry financial risk for the drugs, and CMS used a single central processor in 2026 to handle prior authorization, claims, and payment to pharmacies [1].
Who qualifies
A beneficiary must be enrolled in a standalone prescription drug plan or a Medicare Advantage plan that offers drug coverage, and a prescriber must submit a prior authorization attesting that the drug is prescribed to reduce excess body weight and maintain weight reduction along with ongoing nutrition and physical activity changes [1]. The beneficiary must also meet one of three criteria:
- BMI of 35 or higher; or
- BMI of 30 or higher plus heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above; or
- BMI of 27 or higher plus pre-diabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease [1].
Those thresholds are judged as of when GLP-1 therapy started, not when the prior authorization is filed. CMS gives the example of a beneficiary who began therapy in September 2024 with a BMI of 37 and now has a BMI of 34; the prescriber should attest to the BMI at initiation [1].
People whose GLP-1 prescription is for type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH get coverage through Part D and cannot use the Bridge, even if they also meet its BMI criteria [1].
Why it matters for patients
For eligible beneficiaries, the extension means the $50 monthly copay path stays open through the end of 2027 instead of ending in December 2026 [1][2]. It does not change the clinical criteria, the list of covered drugs, or the rule that the prescription must be for weight management rather than a Part D-covered condition [1].
GLP-1 spending has grown quickly. In 2024 there were 21.8 million Medicare GLP-1 claims and $27.5 billion in gross spending before rebates, and 8.4 million Medicaid prescriptions and $8.6 billion in spending [2]. In KFF polling, 56% of GLP-1 users said the drugs were difficult to afford, including one in four who said they were very difficult to afford [2].
Medicaid is on a separate track: the BALANCE model began for state Medicaid agencies in May 2026 and runs through December 2031 [2]. As of January 2026, 13 states covered GLP-1s for obesity, down from 16 states in 2025 [2].
Semaglutide — sold as Ozempic, Wegovy, and Rybelsus — was selected for Medicare drug price negotiation in 2025, with a negotiated price set to take effect in 2027 [2]. How that negotiated price would interact with the Bridge, which operates outside the Part D benefit, has not been reported. Whether BALANCE will launch in Part D at all, and whether the Bridge would be extended again past 2027, also has not been disclosed [1][2].
What happens next
- The Bridge covers eligible beneficiaries from July 1, 2026, through December 31, 2027 [1][2].
- Medicaid BALANCE runs from May 2026 through December 2031 [2].
- The negotiated Medicare price for semaglutide takes effect in 2027 [2].
- No start date has been announced for BALANCE in Medicare Part D [1][2].
Sources
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