The U.S. government has indefinitely delayed a pilot program intended to provide seniors with discounted weight-loss drugs after private insurers refused to participate.
The Centers for Medicare and Medicaid Services (CMS) had planned to launch the BALANCE pilot in January 2027 to offer popular GLP-1 medications from Eli Lilly and Novo Nordisk.
Under the proposed demonstration, Medicare beneficiaries would have paid a $50 monthly copay, while the drugmakers agreed to a wholesale price of $245 a month for Medicare and Medicaid.
However, the initiative required Medicare Part D drug plans covering at least 80% of enrollees to opt-in by a Monday deadline. Not enough insurers agreed to the terms, leading to the program’s suspension.
Industry officials indicated that insurers were wary of the “financial strain” and the difficulty of predicting how many seniors would seek the treatments.
Medicare Advantage and Part D plans are required to submit their formal bids for the 2027 coverage year by June 1, necessitating a clear decision on the pilot’s status this week.
The BALANCE program was part of a deal struck by the Trump administration last year to lower the costs of obesity drugs in exchange for expanded access within federal health programs.
While federal law currently prohibits Medicare from covering weight-loss drugs, the administration attempted to use the pilot as a mechanism to bypass that restriction.
In place of the suspended pilot, the government will continue to fund access to the drugs through an alternative “Bridge model.” This program, originally intended as a transition to the BALANCE pilot, will now be extended through 2027.
“The continuation of the Medicare GLP-1 Bridge through 2027 will both provide Medicare beneficiaries access to GLP-1 drugs and enable collection of data that will allow plans to prepare for the potential implementation of BALANCE in Part D,” CMS said in a statement.
The extension allows the government to cover the medications outside of the standard Medicare Part D drug benefit, ensuring seniors maintain access to the treatments while the agency gathers usage data for future policy decisions.