Overview
- The pilot stalled after the April 20 opt-in deadline passed without the roughly 80% Part D enrollee coverage CMS required.
- CMS will run a Medicare GLP-1 Bridge from July 1, 2026 through December 31, 2027 to provide access outside the Part D drug benefit at agency‑negotiated prices.
- Beneficiaries will pay a $50 monthly copay for GLP-1 weight-loss drugs such as Wegovy and Zepbound under the bridge.
- Major plans balked at the BALANCE design, with UnitedHealth citing “notable challenges” and CVS saying it would not join.
- Eli Lilly and Novo Nordisk agreed to sell the drugs to Medicare and Medicaid at about $245 per month, but longer-term Part D integration and broader insurer buy-in remain unresolved.