NEJM Interview: Stacie Dusetzina on a new program that will allow Medicare Part D enrollees to obtain GLP-1 medications for use for weight loss.

Historically, Medicare's outpatient prescription drug benefit, Part D, has prohibited coverage of drugs used for weight loss. But in July 2026, the Centers for Medicare and Medicaid Services will launch the Medicare GLP-1 Bridge Program, which will offer Part D enrollees an opportunity to obtain GLP-1 medications for weight loss or weight maintenance. I'm Stephen Morrissey, Managing Editor of the New England Journal of Medicine, and I'm talking with Stacy Dusetzina, a Professor of Health Policy and of Cancer Research at the Vanderbilt University School of Medicine. Dr. Dusetzina has written a perspective article about the Bridge Program. Dr. Dusetzina, why has Part D not covered drugs used for weight loss in the past, and what's changed to make policymakers reconsider it?

Originally, when Medicare Part D was first passed, there was a prohibition on covering certain types of drugs that were considered more lifestyle treatments, and weight loss medications in particular, and using drugs or covering drugs for weight loss was explicitly written into the law. It sounds very archaic today when you think about how science has progressed and how treatments have progressed, but in part that was done because of concerns over unsafe weight loss medications such as fen-phen, which had just been pulled from the market around the time that Medicare Part D was passed back in 2003. So in some ways, this is really related to history rather than being really forward-thinking in the way that we think about weight loss medications today. That said, this ban on coverage for weight loss has continued. And so the GLP-1 Bridge Program is one of CMS's attempts to try to provide access to drugs for weight loss for people on Medicare Part D, but it is a program that is running completely outside of the Medicare Part D benefit. So it isn't a change in policy for Medicare Part D. It is instead that the government is paying for these drugs separate from the program right now.

So what were the original goals of the Medicare GLP-1 Bridge Program, and then how have those shifted in recent months?

So originally, CMS and the Center for Medicare and Medicaid Innovation, CMMI, had proposed to put forward a demonstration project called the Balance Model that had intended to cover weight loss medications and provide lifestyle modification, counseling, and behavioral programs in order to test the benefits of making these drugs more widely available for people with different indications that are not currently covered under Medicare Part D. So this was going to be run as an experiment on expanding the benefit and getting information about potential cost savings. If we resolve people's health conditions or help them live healthier lives, do we end up saving money downstream and preventing things like heart attacks and strokes and other high-cost conditions? So that was a program called Balance. Right now, we have seen that CMS has put Balance on hold, in part because it seemed that Part D plan sponsors, the private plans that run the Medicare Part D program, were not interested in participating in this voluntary model. So in absence of having that program move forward, the