Centene is participating in CMS’ GLP-1 bridge program for Medicare Part D, CEO Sarah London said on an April 28 earnings call.
Under the “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model, CMS would leverage negotiated GLP-1 prices for Medicaid and Medicare Part D, focusing on boosting access for weight-loss purposes. The program also would include lifestyle-focused initiatives.
The bridge demo acts as an on-ramp, offering eligible Part D beneficiaries with some GLP-1 access starting July 1, 2026. The bridge’s end date is now Dec. 31, 2027.
“We are pleased that our Medicare members will have the opportunity to participate in the CMS bridge program, and we support the goal of expanded GLP-1 access for more seniors,” Ms. London said.
While BALANCE is voluntary, Centene is not the only insurer considering the bridge initiative. UnitedHealthcare also expressed interest in the bridge demo during its April 21 earnings call. However, the carrier shared concerns with the overall model.
“We’d like to find a path to ‘yes’ there on coverage over time, but there are some notable challenges and outstanding questions with the currently planned structure,” Bobby Hunter, UnitedHealthcare’s CEO of government programs, said.
Shortly after UnitedHealthcare’s call, CMS confirmed it is holding off on the BALANCE pilot for Medicare Part D, originally set to begin in 2027. Sponsors had until April 20 to apply, but Part D plan sponsors representing 80% of Part D enrollment needed to apply for the model to move forward. State Medicaid programs can still apply through July 31.
“We’ve also been actively engaged in dialogue around the BALANCE model and remain committed to partnering with the administration to leverage data, best practices and lessons learned from the bridge program to position BALANCE for success in the future,” Ms. London added.
A March KFF analysis highlighted unresolved concerns with BALANCE, such as questions surrounding implementation, adherence, regulations and operations.
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