Medicare and GLP-1s: The BALANCE model is a step forward, but patients deserve more than a bridge to nowhere

For decades, people living with obesity have faced a fundamental barrier: lack of access to evidence-based care. Despite obesity being recognized as a chronic, complex, heterogeneous disease, treatment options, particularly medications, have remained out of reach for many Americans due to gaps in coverage and affordability.

On April 21, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the decision to delay implementing the Medicare Part D portion of the Better Approaches to Lifestyle and Nutrition for Comprehensive HEalth (BALANCE) Model until at least 2027, pending further evaluation and data collection. However, CMS will continue advancing other components of the initiative, including the Medicaid portion and a temporary bridge program, now extended through 2027, to expand near-term access to obesity medications by allowing eligible Medicare beneficiaries to receive GLP-1 treatments at negotiated prices while the broader model is refined.

Importantly, this bridge pathway creates a defined window of access beginning July 1, 2026, giving eligible Medicare beneficiaries the ability to receive GLP-1 medications for a limited period while CMS gathers additional data on utilization, outcomes and cost. In the near term, this approach may provide valuable insights into how these therapies are used in real-world settings and help inform more sustainable, long-term coverage decisions.

Even with this delay, implementation of the BALANCE Model will be an important step forward. It is designed to improve access while managing costs by testing new ways to expand coverage for obesity medications through Medicaid and Medicare. By broadening this access, the program begins to address a decades-long gap that has limited care for millions.

But we should be clear: This is a starting point, not a complete solution, and further delays will deprive people living with obesity of potentially lifesaving medications.

Too many patients still lack access to obesity medications as part of comprehensive obesity treatment because of cost and inconsistent coverage from exclusionary denials. Care decisions should be driven by clinical need, not limited by access barriers. While the BALANCE Model begins to expand access, affordability and access must remain central foci. Without it, even the most effective therapies will continue to be out of reach for many patients.

One thing to remember is that obesity is a complex disease and there is no one-size-fits-all solution. GLP-1 treatments help millions of patients, yet they don’t work for some, can’t be tolerated by others or may be medically contraindicated. Those patients deserve treatment too. Patients and providers need access to the full range of treatment options. Expanding coverage allows for better alignment between treatment and individual patient needs, preferences and health profiles. These advancements will ultimately lead to better outcomes and more sustainable care.

A truly effective and comprehensive approach must go beyond medications alone. Obesity treatment should include all evidence-based modalities, including access to lifestyle interventions, the full range of obesity medications and metabolic-bariatric surgery, when indicated. This comprehensive approach must apply not only to Medicare and Medicaid beneficiaries, but also to those with private insurance. Without this full continuum of care, treatment remains incomplete.

State Medicaid agencies will play a critical role in ensuring the success of this model. Their participation in the BALANCE Model and engagement with CMS as it evolves are key to expanding access at scale. States can join between May 1, 2026, and January 1, 2027, and those that do not participate within that window may not have another chance to do so. Engaging these stakeholders to ensure as broad a participation as possible will be essential to ensuring the model reaches its full potential.

As conversations continue about the future of the BALANCE Model, CMS must ensure that its coverage framework reflects current clinical guidance. Aligning the model with recently published joint expert guidance — and specifically including all obesity therapies with a strong recommendation — sends a clear signal that coverage decisions are driven by science, not by product class or cost alone. We must also make room for emerging therapies. Smaller and innovative companies play a critical role in advancing the next generation of treatments, and policies should encourage ongoing research, development and clinical progress. A model that includes only one class of medication narrows the treatment landscape and may discourage the development of diverse, affordable therapeutic options.

People living with obesity deserve more than incremental change. They deserve a health care system that reflects modern science, supports individualized treatment, expands access and affordability, and fosters continued innovation.

The BALANCE Model is a step forward. Now we must ensure it becomes a bridge to something better.

Jonathan Purnell, M.D., FTOS, is a professor of medicine at Oregon Health & Science University (OHSU) in Portland, Oregon, with board certification in both endocrinology and obesity medicine. He is also a professor of the Knight Cardiovascular Institute at OHSU. For more than 20 years, Dr. Purnell has continued to practice obesity medicine in the context of preventive cardiology clinics and has integrated these therapies to optimize patient health. He is currently president-elect of The Obesity Society, the nation’s leading scientific organization dedicated to advancing the understanding, prevention and treatment of obesity.