Coverage & Cost

Medicare GLP-1 Bridge vs the BALANCE Model

The BALANCE Model's Medicare Part D launch was delayed with no new date, and the $50 GLP-1 Bridge now runs through 2027 instead. What each program means.

By Alan Jones · Last updated August 8, 2026

The short answer

The Medicare GLP-1 Bridge is running now. The Medicare side of the BALANCE Model is not. In April 2026, CMS delayed the Medicare Part D portion of the BALANCE Model rather than launching it in 2027, and extended the $50 Bridge through December 31, 2027 instead. If you are on Medicare and want help paying for a GLP-1 today, the Bridge is the program that exists.

What changed in April 2026

BALANCE was originally designed as the broader, longer-term answer for GLP-1 access across both Medicare and Medicaid. That is no longer the near-term picture.

CMS delayed implementation of the Medicare Part D portion of BALANCE, citing the need for further evaluation and data collection, and reporting that plan sponsors were concerned about instability in Part D and did not have a full picture of GLP-1 utilization. No new launch date has been announced.

In CMS's own words on the Medicare GLP-1 Bridge page, the Bridge was extended through December 31, 2027 to keep access open and to let CMS "collect additional data on GLP-1 utilization to share with Part D plan sponsors ahead of potential implementation of BALANCE in Part D."

Note the word potential. BALANCE in Medicare is not scheduled — it is under consideration.

The Medicare GLP-1 Bridge: what is actually running

The Bridge is a time-limited CMS demonstration running July 1, 2026 through December 31, 2027. It gives eligible Part D members a flat $50-per-month copay for weight-management GLP-1s: Wegovy, the Zepbound KwikPen, and Foundayo. It does not cover Ozempic or Mounjaro — see which drugs the Bridge covers.

Your prescriber submits a prior authorization, and because the program sits outside the Part D benefit, the $50 does not count toward your deductible or your annual out-of-pocket cap.

The BALANCE Model: where it stands

BALANCE is not cancelled — but the two halves are on very different tracks.

Medicare (Part D): delayed. Not launching in 2027, with no announced timeline. Nothing for you to enroll in or ask your plan about.
Medicaid: proceeding. CMS accepted applications from state Medicaid agencies through July 31, 2026, with expanded GLP-1 coverage running from 2026 into 2031. Whether it affects you depends on your state and on whether you have Medicaid coverage.

If you have both Medicare and Medicaid, your state's Medicaid program may eventually be relevant — but your Medicare drug coverage is still governed by your Part D plan and, if you qualify, the Bridge.

Side by side

Status today: Bridge — live through December 31, 2027. BALANCE — Medicare portion delayed; Medicaid portion moving forward.
Who runs it: Bridge — a central CMS demonstration outside Part D. BALANCE — designed to work through plans and state Medicaid agencies.
What it covers: Bridge — Wegovy, Zepbound KwikPen, Foundayo for weight management. BALANCE — a broader set of GLP-1s, as designed.
Your cost: Bridge — a flat $50 a month if eligible. BALANCE — not applicable in Medicare at this time.

Which one applies to you

You want a weight-loss GLP-1 at a predictable price. The Bridge is the program to ask your doctor about. Check whether you qualify — it takes about two minutes.
You take a GLP-1 for type 2 diabetes, sleep apnea, or fatty liver disease. These diagnoses make you ineligible for the Bridge, and BALANCE is not an option in Medicare right now. Your route is your regular Part D plan's formulary — and that spending does count toward your annual out-of-pocket cap. Start with does Medicare cover Ozempic and Medicare Advantage GLP-1 coverage.
You were counting on BALANCE. There is nothing to sign up for. Focus on the Bridge if you are eligible, or on your plan's formulary during Open Enrollment if you are not.

What this means for 2028

The Bridge expires December 31, 2027, and with BALANCE's Medicare launch delayed, no successor is currently in place. That does not change anything you do in 2026 or 2027, but it is worth keeping in mind when you compare plans — a plan with a strong GLP-1 formulary is the more durable choice. Our guide to switching Medicare plans for GLP-1 coverage covers how to compare.

If you need a prescriber who handles GLP-1s for Medicare patients, our provider directory can help you find one.

Data note

Data as of August 2026. The status of the BALANCE Model and the Medicare GLP-1 Bridge extension come from CMS and Medicare.gov. Program details can change — confirm current rules with your plan, Medicare.gov, or CMS.gov. This is educational information, not medical or financial advice.

Frequently asked questions

Is the BALANCE Model happening in Medicare?

Not currently. CMS delayed the Medicare Part D portion of the BALANCE Model in April 2026 rather than launching it in 2027, and has not announced a new date. CMS describes it as potential future implementation, not a scheduled program.

Why was the $50 GLP-1 Bridge extended?

Because the Medicare side of BALANCE was delayed. CMS extended the Bridge through December 31, 2027 to keep access open and to collect additional data on GLP-1 utilization to share with Part D plan sponsors.

Was the BALANCE Model cancelled entirely?

No. The Medicaid component is proceeding — CMS accepted state Medicaid agency applications through July 31, 2026, with expanded coverage running into the early 2030s. It is specifically the Medicare Part D portion that was delayed.

I have type 2 diabetes. Does BALANCE help me?

Not in Medicare at this time. A type 2 diabetes diagnosis also makes you ineligible for the $50 Bridge. Your route is your regular Part D plan's formulary, and that spending does count toward your annual out-of-pocket cap.

What happens after the Bridge ends in December 2027?

No successor is currently in place, since BALANCE's Medicare launch was delayed. If you rely on the $50 copay, it is worth favoring a plan with a strong GLP-1 formulary when you compare options during Open Enrollment.

The Prescription Payment Plan and GLP-1s →

The Medicare Prescription Payment Plan spreads drug costs across the year. Here's why it can't be used for the $50 GLP-1 Bridge copay — and when it helps.

Medicare Open Enrollment 2027 and GLP-1s →

Medicare Open Enrollment runs October 15 to December 7, 2026. Here's what GLP-1 users should check before choosing a 2027 Part D or Medicare Advantage plan.

Switching Medicare Plans for GLP-1 Coverage →

Medicare open enrollment runs Oct 15–Dec 7. How to compare Part D and Medicare Advantage plans for GLP-1 coverage in 2027 — and how the $50 Bridge fits in.

Put it into practice

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GLP1 Almanac is an independent reference site. Articles are educational and are not medical advice. Always verify coverage details with your plan or Medicare.gov, and consult your doctor about your care.