The Centers for Medicare & Medicaid Services (CMS) has hit pause on its pilot programme designed to offer insurer-fronted access to cheaper weight loss medications, as some insurance companies decline to contribute to the scheme.
This call, which was shared via an email subsequently made public, will see the Centers for Medicare & Medicaid Services (CMS) enact its Medicare GLP-1 Bridge scheme – meaning the agency’s Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) programme will be pushed back.
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With the BALANCE programme on ice, the government will now front the cost of weight loss medications for beneficiaries through the bridge scheme between 1 July 2026 and 31 December 2027 as coverage discussions with insurers continue.
In the email, CMS noted that it will delay the implementation of the BALANCE scheme pending “further evaluation and data collection”, which the agency says will help “inform the potential implementation of BALANCE in Part D”.
CMS’ decision to extend the bridging period comes as prominent American healthcare insurers like UnitedHealth and CVS say that certain elements of the BALANCE proposal need amending before each party can join, as reported by Bloomberg.
It also comes a couple of days after the deadline (20 April) for insurers to opt in to the BALANCE programme expired, which saw CMS fail to secure the 80% sign-up rate necessary for the scheme to continue.
CMS created the BALANCE scheme to enhance senior accessibility to glucagon-like peptide 1 receptor agonist (GLP-1RA)-based obesity therapies like Novo Nordisk’s Wegovy (semaglutide) and Eli Lilly’s Zepbound (tirzepatide), as a course of each drug would have once set a patient back up to $1,350 or $1,086 a month.
To bring prices down, the Trump administration signed deals with both Eli Lilly and Novo Nordisk centred around their weight loss drugs, which saw the companies pledge to drop prices in exchange for expanded coverage via Medicaid and Medicare.
In a statement to Pharmaceutical Technology, Novo Nordisk said: “We welcome the upcoming launch of Medicare GLP-1 Bridge to help eligible Medicare patients access Wegovy in both injectable and pill form with a flat $50 monthly copay.
We are committed to working with stakeholders to support Medicare GLP-1 Bridge implementation and identify long-term access solutions for America’s seniors.”
There is currently no set date available for when the BALANCE programme will come into effect.
