GLP-1 Access: CMS Bridge Expands Coverage — But Only Temporarily

The Centers for Medicare & Medicaid Services (CMS) announced the Medicare GLP-1 Bridge, a temporary demonstration program offering coverage for select GLP-1 drugs to eligible Medicare Part D beneficiaries with obesity starting July 1, 2026, through December 31, 2027. Eligibility criteria for the Bridge include beneficiaries with a BMI of 35 or higher with no additional requirement, or a BMI of 30 or higher with comorbid conditions such as heart failure or uncontrolled hypertension, as detailed by the American Journal of Managed Care (AJMC). The CMS press release states the Bridge provides access 'for Medicare beneficiaries with obesity' but does not specify these BMI thresholds; the AJMC article clarifies the eligibility tiers. This temporary coverage is a step forward but leaves patients and providers in limbo after 2027.

The BALANCE Model, which aims to expand GLP-1 access more broadly, faces a key delay: on April 21–22, 2026, CMS postponed the Medicare Part D portion, explicitly instructing Part D sponsors not to indicate BALANCE participation for CY 2027. The Medicaid portion continues, but the Medicare delay means millions of seniors lack a permanent pathway to coverage. While semaglutide was selected for Medicare price negotiation under the Inflation Reduction Act in January 2025, with negotiated prices expected to take effect in 2027 (per HHS and AJMC), the Bridge and BALANCE delays reflect a system still treating obesity coverage as a temporary experiment rather than a right. A universal-access approach would require permanent coverage and robust price negotiation for all beneficiaries.