Trump Administration Delays Medicare Pilot Program to Cover Weight-Loss Drugs - What to Know

The Trump administration's promised Medicare pilot program for GLP-1 weight-loss drugs was positioned to help cover the costs of these medications, helping seniors avoid wasting money in retirement while supporting their health. According to a 2025 study in the Cleveland Clinic Journal of Medicine, 41.5% of United States adults aged 60 years and older have obesity, so the pilot might have made a significant impact on senior health.

However, a delay to the pilot program means changes for Medicare beneficiaries who are on or who want to begin weight-loss medications. Here's what to know about the pilot, where it stands now, and what it means for your access to these medications.

The background on the GLP-1 weight-loss drug pilot program

Law prohibits the Medicare program from covering weight-loss drug costs. The Medicare pilot program, called the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) program, was a workaround.

The BALANCE program would have allowed the Centers for Medicare & Medicaid Services (CMS) to negotiate directly with GLP-1 drug manufacturers who participated in the program. Participation in the program would be voluntary, and Medicare beneficiaries would have been able to access the drugs for a $50 co-pay.

Why the BALANCE program has stalled

The Trump administration signed a deal with Eli Lilly and Novo Nordisk last year in which the companies agreed to cut the prices on their drugs in exchange for getting their weight loss medications to a new patient pool.

However, the BALANCE program depended not only on negotiating with drug manufacturers, but also on Medicare drug plans covering 80% of certain beneficiaries choosing to participate in the pilot. Insurers had to choose to participate in the pilot by April 20.

CMS ultimately failed to secure enough signups from insurers to continue with the pilot at this time.

Why insurers failed to sign up

CVS Health and UnitedHealth declined to participate in the BALANCE program. Bobby Hunter, UnitedHealth CEO of government programs, referenced concerns about the BALANCE program during a Tuesday morning call, stating, "We would like to find a path to yes on coverage over time, but there are some notable challenges and outstanding questions with the currently planned structure."

Financial strain may have factored into insurers' decision to decline. Drugmakers had agreed to sell their treatments for $245 to Medicare and Medicaid beneficiaries, a reduced rate. However, Medicare indicated that beneficiaries would pay just $50 per month for the medications. If insurers were expected to absorb the difference, that could be a steep recurring expense.

What happens now

The five-year BALANCE program will be delayed, but that doesn't mean that Medicare beneficiaries will lose weight-loss drug coverage. A transitional program is scheduled to begin in July and run through the end of 2027, allowing Medicare to cover the weight loss drugs.

Through the bridge program, eligible beneficiaries may purchase Wegovy and Zepbound for a $50 copayment. Beneficiaries must have BMI of 35 or more alone, or 27 or more when paired with other clinical criteria. Beneficiaries must also be enrolled in Medicare Part D to participate.

Understanding the potential downsides to the bridge program

The bridge program is designed to help expand access to weight-loss drugs to seniors, but it comes with some drawbacks. The program operates outside of the Medicare Part D benefit, so although beneficiaries must be enrolled in Medicare Part D, their $50 copayments don't count toward the Part D deductible or the $2,100 out-of-pocket spending cap.

Low-income beneficiaries who have reduced cost-sharing can't use their subsidy for weight-loss drug prescriptions, so the copayment could be a financial barrier.

What the bridge program means for Medicare beneficiaries using GLP-1 medications for other conditions

If beneficiaries use a GLP-1 medication for a health condition like diabetes or sleep apnea, they must continue using their Part D coverage to access the medication. Beneficiaries are required to use their Part D coverage even if their Part D copayment is more than the $50 copayment available under the bridge program.

What might happen with the BALANCE program

The BALANCE model's Medicare Part D launch was scheduled to begin in July 2026, but it has been pushed to 2027 at the earliest. Until then, the Medicare program will cover the drug costs on its own. States have until July 31 to apply to participate in the Medicaid portion of the pilot.

As the Medicare pilot moves forward, CMS indicated in a memo that the extra time and data should "inform the potential implementation of BALANCE in Part D."

Bottom line

The Medicare bridge program has some drawbacks, but it helps Medicare beneficiaries still access these weight-loss drugs. The $50 copay benefit is on track beginning in July 2026, but the full implementation of the BALANCE model remains delayed and depends on sufficient insurer participation.

If you're considering a weight-loss drug, your doctor may be able to help you explore ways to save on its cost, including through coupons and savings or discount cards. Health insurance coverage like Medicare Part D, which helps cover some of your medication expenses, can be a key component of your retirement plan, helping you keep more of your cash while prioritizing your health.

You May Also Like

7 Ways To Get Money Without Getting A Second Job

Read More

How To Save Money on Car Insurance: 12 Ways to Lower Rates

Read More

10 Things Seniors Born Between 1941-1969 Could Take Advantage Of

Read More

19 Dumbest Things Smart People Waste Money On

Read More

7 Moves If You Want to Stop Living Paycheck to Paycheck

Read More

7 Clever Ways to Crush Your Debt

Read More

Have $150K+ in Assets? See If You Can Retire Early

Zoe Financial Benefits

• Get matched with vetted and fiduciary-certified financial advisors
• Take the mystery out of retirement planning
• Their matching tool is free

Find an advisor

Paid Non-Client Promotion

FinanceBuzz doesn’t invest its money with this provider, but they are our referral partner. We get paid by them only if you click to them from our website and take a qualifying action (for example, opening an account.)

---

Subscribe Today

Learn how to make an extra $200

Get vetted side hustles and proven ways to earn extra cash sent to your inbox.

or

Subscribe Now →

By submitting this form you agree to receive emails from FinanceBuzz and to the privacy policy and terms