Status check: BALANCE state window closes January 1 with one committed state and no CMS participant count
CMS still lists no participant count for its BALANCE Medicaid drug-price model with about 109 days left in the rollout window, and the Medicare half of the program remains indefinitely delayed.
The federal government's plan to lower what state Medicaid programs pay for GLP-1 obesity drugs is running out of runway with almost nothing public to show for it. The BALANCE Model's Medicaid rollout window closes January 1, 2027 — roughly 109 days from mid-September 2026 — and the CMS model page still lists the number of participants as "not applicable" [1].
BALANCE, short for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth, is run by the Centers for Medicare & Medicaid Services and lets CMS negotiate GLP-1 prices with manufacturers on behalf of states and, originally, Medicare Part D plans [1][2]. Participation is voluntary for drugmakers, states and plans, and that voluntary structure is where the program has stalled [1]. Reporting has publicly identified only one state, Indiana, as committing, and CMS has published no official list or count [1].
What the timeline actually says
KFF's timeline shows the Medicaid side of BALANCE launching May 1, 2026, with states coming online on a rolling basis until January 1, 2027, and running through December 31, 2031 [2]. That same timeline lists July 31, 2026 as the deadline for state Medicaid agencies to submit applications — a date that has already passed without a published participant count [1][2].
The Medicare half went a different direction. Part D sponsors had until April 20, 2026 to apply. On April 21, 2026, CMS announced an indefinite delay of the BALANCE Model in Part D and instead extended a separate short-term program, the Medicare GLP-1 Bridge, through the end of 2027 [2].
The Bridge runs July 1, 2026 through December 31, 2027, after originally being scheduled to end December 31, 2026 [2]. It is nationwide and sits outside normal Part D coverage, so plans do not have to opt in and do not carry the financial risk [2]. Eligible Part D enrollees pay a $50 monthly copay for GLP-1s approved for weight reduction: all formulations of Foundayo (orforglipron) and Wegovy (semaglutide), plus the KwikPen formulation of Zepbound (tirzepatide) [2]. A prescriber must submit a prior authorization attesting the drug is for weight reduction and maintenance and that the patient meets one of three criteria — 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 [2].
Why it matters for patients
The stakes are concrete. Medicare is prohibited by law from covering drugs used specifically for weight loss, and Medicaid coverage for obesity is optional for states [2]. Only 13 states covered GLP-1s for obesity as of January 2026, down from 16 in 2025, a drop KFF attributes to coverage costs, state budget pressure and federal funding cuts [2]. If a state does not join BALANCE, its enrollees are left where they were.
Affordability is already the pinch point. KFF polling found 56% of GLP-1 users said the drugs were difficult to afford, including one in four who called it "very difficult" [2]. Meanwhile, spending keeps climbing: in 2024 there were 8.4 million GLP-1 prescriptions and $8.6 billion in Medicaid spending, and 21.8 million claims and $27.5 billion in gross Medicare spending before rebates [2].
For people on Medicare, the Bridge is time-limited coverage, not a permanent benefit. What happens to obesity prescriptions when it expires has not been announced.
What happens next
- January 1, 2027: the window for state Medicaid agencies to implement BALANCE closes [2].
- 2027: the negotiated Medicare price for semaglutide (Ozempic, Wegovy, Rybelsus), selected for drug price negotiation in 2025, takes effect [2].
- December 31, 2027: the Medicare GLP-1 Bridge ends [2].
- December 31, 2031: BALANCE ends for state Medicaid agencies [2].
What, if anything, covers Medicare obesity prescriptions starting in 2028 is not yet known. BALANCE in Part D remains indefinitely delayed, with no new implementation date announced [2].
Sources
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