Medicare will not cover GLP-1s for weight loss: 3 notes 

Advertisement

CMS said April 4 it will not move forward with a Biden-era proposal to allow Medicare coverage of GLP-1 drugs when prescribed solely for weight loss.

Three notes: 

1. While the agency is not currently moving forward with a proposal for Medicare to cover anti-obesity drugs for weight loss, it may revisit the policy in the future, CMS said in a fact sheet.

2. Toward the end of his term in November, former President Joe Biden issued a proposal for Medicare and Medicaid to cover GLP-1s for weight loss, a move that would have dramatically expanded access to the treatments for people with obesity. Currently, Medicare covers GLP-1s only to treat diabetes and heart disease. 

3. In 2023, Medicare spent roughly $35.8 billion on 10 common diabetes drugs, including GLP-1 medications. The Congressional Budget Office previously estimated that authorizing Medicare coverage for weight loss drugs would cost the federal government around $35 billion over nine years. Such a policy would have made nearly 13 million older Americans eligible for coverage. 

At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.

Register to Attend Webinar

How Leading Pharmacies Stay Stocked And Protect Margins

Thursday, July 23
12:00 PM - 1:00 PM CDT

Presenters: Calvin Hunsicker, SureCostChad O’Connor, SureCost

Advertisement

Next Up in GLP-1s

Advertisement