CMS indefinitely delayed its Medicare BALANCE model—intended to open Medicare Part D coverage pathways for obesity drugs—after a lack of participation by insurers. Instead, the agency extended its temporary “GLP-1 Bridge” demonstration model through the end of 2027, shifting near-term coverage planning into a longer runway with state options still available for Medicaid participation. The policy change signals that payer economics and operational requirements remain decisive for whether Medicare beneficiaries get access to lower-priced obesity treatments. It also affects manufacturers’ pricing and contracting assumptions tied to Medicare access expansion. For biotech and pharma with GLP-1 and dual-agonist assets, the BALANCE pivot increases uncertainty around timing for broader Medicare uptake even as demand continues. Companies may be forced to re-evaluate go-to-market timelines while CMS maintains a trial-based framework for coverage expansion.