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Medicare Weight-Loss Drug Pilot Delayed
23 Apr
Summary
- Pilot program for Medicare weight-loss drugs is postponed.
- Insurers declined to participate in the coverage initiative.
- Existing Medicare beneficiaries will retain drug coverage.
The Trump administration has delayed a pilot program that would have allowed Medicare to cover the costs of GLP-1 weight-loss drugs, such as Wegovy and Zepbound. This decision comes after major health insurance companies declined to participate in the initiative, dubbed BALANCE. Insurers expressed significant concerns regarding the program's current structure.
Despite the pilot program's delay, individuals enrolled in Medicare who are already taking these weight-loss drugs will continue to receive coverage. A transitional program, set to begin in July and run through the end of 2027, will ensure continuity of care. Under this arrangement, Medicare itself will bear the expense, rather than individual insurance companies.
The delay provides the Centers for Medicare & Medicaid Services with additional time to determine the most effective path forward for the pilot program. While President Trump had previously promoted deals aimed at lowering drug prices for Medicare recipients, securing coverage for GLP-1s has presented unique challenges. Without insurance, these medications can cost over $1,000 monthly, though manufacturers offer coupons and reduced prices for some doses.
