Healthcare Roundtable, July 6, 2026:
New research from KFF found that 3.8 million Medicare Part D enrollees are eligible to participate in the Medicare GLP-1 Bridge program. Last year, the Centers for Medicare and Medicaid Services (CMS) announced new model that would offer Medicare and Medicaid enrollees access to GLP-1 medications, called the Better Approaches to Lifestyle and Nutrition for Comprehensive Health (BALANCE) Model, which was slated to launch for Medicare Part D beneficiaries in July 2026 and was indefinitely postponed due to inadequate insurer participation. To provide Medicare Part D beneficiaries with access to the medications in the interim, CMS established and expanded a GLP-1 Bridge program, which would provide beneficiaries with GLP-1s outside of the Part D program. Beneficiaries would need to be enrolled in Medicare Part D, meet a clinical threshold, undergo prior authorization, and pay a $50 co-pay.
Using 2023 data on traditional Medicare and Medicare Advantage (MA) enrollees, KFF found that 9.7 million Medicare enrollees met the clinical criteria for the Bridge program. Of these beneficiaries, 39% (3.8 million) were eligible for the Bridge program while the remaining were eligible for the medication through existing Medicare coverage policies. Although the total cost to the federal government depends on utilization of the program, if between 10 percent to 75 percent of eligible Medicare Part D beneficiaries were to participate in the Bridge program in the first 18 months, Medicare would spend between $1.3 to $10 billion dollars by the end of 2027. At the end of 2027, the Bridge program is expected to come to a close, leaving Part D sponsors responsible for beneficiaries access to GLP-1 medications.