Rob Lourenco, Vice President of Deft Research – Late last year, CMS announced the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model, a new program intended to expand access to GLP-1 medications. There are two major challenges the program aims to address: the limited access to obesity treatments and the high cost of GLP-1 medications. Originally designed to start in 2027, under this initiative CMS would negotiate pricing directly with participating manufacturers and provide certain drugs, including Wegovy and Zepbound, for a flat $50 per month.

This promising program has one hurdle: federal law (Medicare Modernization Act of 2003) prohibits Part D from covering weight loss drugs. Presently, Part D coverage of GLP-1s is for diabetes treatment only. This is where the GLP-1 Bridge Program comes in. This demonstration program, which began July of this year, provides these medications at reduced rates while CMS captures feedback from participants and provides further clarity.

The Medicare portion of BALANCE was originally scheduled to launch on January 1, 2027, but given that not enough Part D sponsors opted in, it has been delayed. The bridge program has also been extended through December of 2027.

Despite these speed bumps, this initiative may provide seniors with benefits beyond weight loss. Studies have shown these medications can improve metabolic health, reduce the risk of cardiovascular events (e.g., heart attacks, strokes), and slow the progression of kidney disease in certain populations.

The implications for Medicare Advantage could also be substantial. Deft’s recently published SNP Experience Study found that 39% of C-SNP eligible beneficiaries are living with obesity. This was the number one response in a list that included diabetes at 27%. Cardiovascular disorders and chronic heart failure combined made up 23% of the sample.

Though obesity is one of the 24 chronic conditions eligible for a C-SNP, only one obesity-focused plan is available among the 548 offered in 2026. If this initiative solves for cost, insurers may be willing to introduce C-SNP plans designed for beneficiaries living with obesity. And with the right care management and wellness programs, this effort could create a meaningful impact on beneficiaries’ health outcomes for years to come.

*The data slide comes from Deft’s 2026 SNP (C-SNP and D-SNP) Experience Study published June, 2026