What physicians need to know about Medicare's new obesity drug coverage, with Tracy Zvenyach, Ph.D., M.S., RN, of the Obesity Action Coalition

For years, Medicare and Medicaid effectively excluded coverage for the medications proven to treat obesity. That is starting to change. In 2026, CMS rolled out two new programs, the Medicare GLP-1 Bridge and the Medicaid-focused BALANCE Model, that open access to GLP-1 drugs for eligible beneficiaries and signal a shift toward treating obesity as a complex chronic disease.

In this episode, Medical Economics Senior Editor Richard Payerchin speaks with Tracy Zvenyach, Ph.D., M.S., RN, vice president for advocacy and research at the Obesity Action Coalition, about what those programs do and what they mean for primary care. Zvenyach explains how the two programs differ, the central role physicians will play in determining eligibility and why CMS's move represents a real policy shift after years of debate. She also digs into the persistent problem of drug pricing, where compounded GLP-1 drugs fit in, the place of metabolic and bariatric surgery in comprehensive care and the weight bias and stigma that still shape how patients are treated across the health care system.

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Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:26 | Sponsor message Copic medical liability insurance.

0:26 – 0:53 | Cold open Zvenyach previews the throughline of the episode: the workarounds patients rely on are a direct result of a system that wasn't built to support people living with obesity.

0:53 – 1:42 | Introduction Austin Littrell introduces the episode and guest, previewing the federal push to expand coverage of GLP-1 drugs and what it means for primary care.

1:42 – 2:50 | Meet Tracy Zvenyach and the OAC Richard Payerchin opens the conversation, and Zvenyach introduces the Obesity Action Coalition, a national nonprofit focused on access to evidence-based obesity care and reducing weight bias and stigma.

2:50 – 4:19 | Is obesity finally treated as a disease? Zvenyach reflects on 15 years of advocacy and says the old "eat less, move more" framing is fading as medical guidelines and policymakers increasingly recognize obesity as a complex chronic disease.

4:19 – 6:46 | What primary care physicians are saying Zvenyach describes a spectrum of clinician comfort with obesity medicine, from fully fluent to resistant, and says policy and coverage barriers make it hard for any of them to get patients the full range of treatments.

6:46 – 8:59 | What the BALANCE model does Zvenyach explains the Medicaid-focused BALANCE model, which pairs GLP-1 access with a lifestyle support program at a negotiated $245 price, and notes the Medicare arm was recently split off into a separate program.

8:59 – 10:32 | BALANCE vs. the GLP-1 Bridge The two programs share the same negotiated price and nearly identical clinical criteria, Zvenyach says, but are now split by population: Bridge covers Medicare from July 2026 through 2027, while BALANCE is a voluntary program for state Medicaid plans.

10:32 – 12:30 | Eligibility and the physician's role GLP-1 access won't be automatic. Zvenyach explains that clinicians must attest a patient meets BMI-based criteria, giving physicians a central role in identifying candidates for the programs.

12:30 – 13:21 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

13:21 – 14:50 | Will there be enough time to prove it works? With Bridge set to run only through 2027, Zvenyach explains CMS's plan to gather outcomes and cost data and potentially fold it into BALANCE in 2028, though carrying it forward depends on insurers opting in.

14:50 – 17:31 | Why covering these drugs is a policy shift Responding to the long debate over whether Medicare and Medicaid should pay for GLP-1 drugs, Zvenyach explains how prior administrations read the statute as barring coverage of "weight loss drugs," and argues these are obesity treatments, with weight loss being an outcome rather than the disease itself.

17:31 – 19:47 | The drug pricing problem Zvenyach summarizes the OAC's stance on antiobesity drug pricing: costs have fallen over the past 12 to 18 months, but coverage still isn't part of most standard benefits, leaving many patients unable to afford treatment even through alternative programs.

19:47 – 21:34 | Where compounded GLP-1s fit in Zvenyach frames the rise of compounded GLP-1 drugs as a symptom of system failure, and urges patients to weigh the different safety and risk profile of compounded versus FDA-approved products while the OAC works to close the coverage gaps that push people toward them.

21:34 – 23:15 | The role of surgery Zvenyach makes the case for the full continuum of obesity care, including metabolic and bariatric surgery and newer endoscopic procedures, noting many patients need more than one type of intervention over the course of their treatment.

23:15 – 26:21 | Weight bias, stigma and people-first language In her closing thoughts, Zvenyach points to weight bias and stigma as the root of many barriers, from exclusionary policy language to how exam rooms are equipped, and calls for people-first language and more respectful media representation.

26:21 – End | Outro Austin Littrell thanks the guest and wraps the episode.