2026年4月22日 下午1:05 UTC / 路透社
作者：玛丽安·E·桑尼
2026年4月22日 下午1:05 UTC 更新于2小时前
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2024年6月27日的插画中可见美国国旗与药品。路透社/达多·鲁维奇 购买授权许可
4月22日（路透社）——分析师表示，由于健康保险公司对参与该项目犹豫不决，美国医疗保险（Medicare）覆盖肥胖症药物的试点项目推迟，不太可能削弱减肥治疗的近期需求。
美国医疗保险与医疗补助服务中心（CMS）周三告诉路透社，该项目名为“综合健康生活方式与营养更佳途径”（BALANCE）的医疗保险D部分试点将推迟至2027年实施，以“开展数据收集工作，为未来更有效的落地提供支持”。
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该试点方案于去年年底公布，旨在让医疗保险和州医疗补助计划绕过针对减肥治疗的报销禁令。
CMS表示，将通过过渡项目维持报销覆盖，时间从2026年7月1日至2027年12月31日，让参保受益人能够按照唐纳德·特朗普总统与礼来公司（LLY.N）和诺和诺德公司（NOVOb.CO）达成的协议中约定的议价价格使用肥胖症药物。
分析师称，过渡项目的期限从原定的2026年延长至2027年，缓解了减肥药物报销方面的不确定性，也削弱了其对需求的近期冲击，但无限期推迟则会让医保处方药计划永久纳入该福利的长期前景蒙上阴影。
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摩根大通分析师克里斯·肖特表示：“从更长远来看，一旦这项肥胖症福利政策确立，我们认为到2028年及以后，无论从实际操作还是政治层面来看，都很难将其撤销。”
CVS健康公司（CVS.N）周二证实，该公司未在4月20日的截止日期前选择参与BALANCE项目，而联合健康集团（UNH.N）则指出“当前规划的项目结构存在显著挑战和悬而未决的问题”。
该试点模式将允许CMS协商确定保证净价，并制定标准化的报销条款，从而有可能限制GLP-1类减肥药物的自付费用上限。
CMS表示，将推进BALANCE项目中的医疗补助部分，各州可于2026年7月31日前提交申请。
花旗分析师杰夫·米查姆表示，尽管推迟并不理想，但将过渡项目延长至2027年是一个可以接受的权宜之计。他补充称，保险公司的反对主要并非针对这类治疗的广泛可及性，而是针对医疗保险D部分计划的不稳定性以及使用情况的不确定性。
Evercore分析师伊丽莎白·安德森表示，此次推迟将给健康保险公司留出时间，在无需承担定价风险的情况下观察GLP-1类药物的实际使用情况，并且有可能在试点项目正式启动后鼓励更广泛的参与。
玛丽安·桑尼在班加罗尔报道；阿尼尔·德席尔瓦编辑
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Delay in Medicare pilot for obesity drugs may not hurt near-term demand, analysts say
2026-04-22 1:05 PM UTC / Reuters
By Mariam E Sunny
April 22, 2026 1:05 PM UTC Updated 2 hours ago
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U.S. flag and medicines are seen in this illustration, June 27, 2024. REUTERS/Dado Ruvic Purchase Licensing Rights
April 22 (Reuters) – A delay in a Medicare pilot to cover obesity drugs due to health insurers’ hesitation to participate in the program is unlikely to dent near-term demand for weight-loss treatments, analysts said.
The Centers for Medicare & Medicaid Services told Reuters on Wednesday it would delay the implementation of the Medicare Part D portion of the program called the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) for 2027 to “allow data collection that would support a more effective potential implementation”.
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The model was announced at the end of last year as a way for Medicare and state Medicaid plans to bypass a prohibition on covering weight-loss treatments.
The CMS said it would maintain coverage through a bridge program from July 1, 2026 to December 31, 2027, giving beneficiaries access to obesity medicines at prices negotiated under President Donald Trump’s deal with Eli Lilly (LLY.N) and Novo Nordisk (NOVOb.CO).
The extension of the bridge program beyond its 2026 expiry eases uncertainty around reimbursement for weight-loss drugs and blunts any near-term impact on demand, but an indefinite delay clouds long-term visibility on permanent integration into Medicare prescription drug plans, analysts said.
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In the longer term, “once this obesity benefit is established, we believe it will be practically and politically difficult to roll back as we look toward 2028 and beyond,” J.P.Morgan analyst Chris Schott said.
CVS Health (CVS.N) confirmed on Tuesday that it did not opt in to participate in the BALANCE program before the April 20 deadline, while UnitedHealth (UNH.N) flagged “notable challenges” and outstanding questions with the currently planned structure”.
The model would allow CMS to negotiate guaranteed net prices and set standardized coverage terms, potentially capping out-of-pocket costs for GLP-1 weight-loss drugs.
CMS said it would move forward with the Medicaid portion of the BALANCE Model, with applications open to states through July 31, 2026.
While the delay is not ideal, extending the bridge program through 2027 is an acceptable workaround, Citi analyst Geoff Meacham said, adding that insurers’ pushback has focused less on broad access to the treatments than on instability in Medicare Part D plans and uncertainty around utilization.
The delay would give health insurers time to observe real-world use of GLP-1 drugs without absorbing pricing risk and potentially encourage broader participation once the model goes live, Evercore analyst Elizabeth Anderson said.
Reporting by Mariam Sunny in Bengaluru; Editing by Anil D’Silva
Our Standards: The Thomson Reuters Trust Principles.
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