Medicare May Cover Weight Loss Drugs Soon

Medicare is preparing to offer coverage for highly sought-after weight loss drugs to some beneficiaries through a voluntary model program. Eligible individuals could soon access these medications for as little as $50 per month, marking a significant shift from current restrictions that ban Medicare coverage for weight loss drugs.

The new initiative, named the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model, is designed to enhance beneficiaries' health by providing greater access to GLP-1 medications. This program, set to begin with a short-term demonstration in July 2026 and a full launch for Part D plans in January 2027, will also incorporate lifestyle support to promote overall well-being while controlling costs for both patients and taxpayers.

This move builds upon efforts to democratize access to weight-loss medication, with the administration negotiating prices with drug manufacturers like Eli Lilly and Novo Nordisk. Eligibility criteria will include individuals who are overweight with prediabetes or cardiovascular disease, or those with obesity, diabetes, or uncontrolled high blood pressure. It is estimated that around 10% of Medicare enrollees will qualify for this expanded coverage, with the goal of making the program cost-neutral through negotiated price reductions.