Medicare’s GLP-1 Bridge Model Expands Obesity Drug Access

Cristy Gallagher, MPAff, research project director at STOP Obesity Alliance, explains how the Balance Model and a new glucagon-like peptide-1 (GLP-1) bridge program aim to expand access to obesity medications under Medicare and Medicaid, highlighting the critical role of pharmacists in patient care. Historically, Medicare Part D has excluded coverage for weight loss and weight gain medications due to an early prohibition in the program, which the Centers for Medicare and Medicaid Services (CMS) has consistently interpreted to bar coverage—even as effective GLP-1 obesity drugs have become available.

In 2024, the Biden administration proposed a rule reframing obesity as a chronic disease and classifying GLP-1 medications as obesity treatments rather than simple weight loss drugs. Advocates pushed to keep this rule in place during the Trump administration in 2025, but it was not implemented, partly due to concerns about potential litigation. As a result, CMS developed the BALANCE Model through the Center for Medicare and Medicaid Innovation (CMMI) to test new approaches to obesity treatment coverage.

The BALANCE Model covers both Medicare and Medicaid, but the Medicare component has been delayed until 2027. In the interim, CMS is using its 402 authority to implement the GLP-1 Bridge Model, starting July 1, 2026, and running through the end of 2027. This bridge program will provide roughly 16 months of coverage, with the goal of encouraging Part D plans to adopt the BALANCE Model for Medicare afterward.

Pharmacists are central to both models. Under Medicaid’s implementation, patients receive a prescription and work with pharmacists to complete prior authorization, verify clinical criteria, and manage adverse effects and dose adjustments. The models also require manufacturers like Eli Lilly and Novo Nordisk to provide lifestyle intervention programs, ensuring that patients on GLP-1 therapies receive education on nutrition, adequate protein and fiber intake, and comprehensive obesity care alongside medication.

“All [of] this is still really brand new, but that's just important that there is that available benefit as well,” Gallagher said. “Because when people take GLP-1s, a lot of times their hunger is sort of not there, and they need to make sure that they're still eating, that they are getting enough protein and enough fiber and enough of that nutrients, even though their calorie intake might be going down.”