Medicare pauses BALANCE GLP-1 pilot as transitional coverage extends through 2027

The Trump administration indefinitely delays the BALANCE pilot that would have let private Medicare drug plans cover GLP-1 weight-loss medicines, after insurers voiced concerns, while a transitional program will cover the drugs through 2027 with Medicare bearing the cost and no requirement for plans to take on financial risk. This means $50 co-pays won’t count toward deductibles or out-of-pocket max for the time being. The Medicaid portion of the initiative continues, with states able to apply by July 31, and analysts see the move as buying time to reassess BALANCE while keeping access available for beneficiaries.