‘Essential’ Drug Coverage Including Obesity Treatments Make Sense For ACA Plans, CMS Says
But the Centers for Medicare and Medicaid Services wants to see data first on how promoting coverage of the new obesity drugs would impact uptake, plan costs and beneficiary premiums.
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Copay Maximizers May Be Restricted In Small Private Plans Under CMS Proposal: Will Broader Impact Follow?
The Centers for Medicare and Medicaid Services requests stakeholder feedback on how extensively copay maximizers are being used by insurers, which could help pave the way for restrictions on large employer and self-insured plans.
Sen. Bill Cassidy and an obesity advocacy group suggest studies test whether obesity patients could be switched to a cheaper maintenance medicine or diet after their initial weight loss on GLP-1s. Approval of Lilly’s Zepbound is a reminder of the expected surge in utilization for the class.
Insurer's concerns about the cost of covering drugs that could be used by large swaths of the population has contributed to their reluctance to pay for them, but in comments to the agency, drug firms, consumer advocates and medical professionals urged the Centers for Medicare and Medicaid Services to promote coverage in the commercial plans governed by the Affordable Care Act.