University of Wisconsin-Madison, Division of Pharmacy Professional Development’s Post

LACK OF COVERAGE BY MEDICARE PUTS NEW WEIGHT LOSS DRUGS OUT OF REACH FOR MILLIONS OF OLDER AMERICANS #healthcare #medicare #medicines #weightloss #weightlosstransformation #insurancecoverage #reimbursement #medications #fda #medicarepartd #drugdevelopment #drugprices #medicaid #centersformedicaremedicaidservices #obesity #obesityawareness

Should GLP-1 (Weight loss drugs) be covered under Medicaid and Medicare? Right now, Medicare Part D plans do not cover any weight loss drugs. The Biden-Harris administration has referred to these medications as “lifesaving”. The problem is that these drugs are very expensive. A year supply of Wegovy could cost an average of $16,000. See article below for more details. #health #healthnews #healthblog #medical #medicalnews #newblogpost #CMS #Medicaid #Medicare #Weightloss #digitalhealth.  https://lnkd.in/eM6g2Bgz

Current administration has proposed a new rule that would allow #Medicare and #Medicaid coverage of #weightloss drugs. *** Current access *** - Medicare is forbidden by statute from covering drugs for weight loss. - Only 13 state Medicaid programs pay for the medications like GLP-1 RA for weight loss. - Many commercial payers exclude GLP-1s from coverage — fewer than 1 in 5 employer - sponsored plans covered them in 2024. - More than 40% of Americans are obese, and expected to reach 50% by 2030. - Obesity can cause or worsen other significant medical conditions, like heart disease, diabetes, strokes and some cancers. - Many patients are resistant to the traditional weight loss modalities, like lifestyle modifications and diet. - Research shows that GLP-1s may lower the risk of other chronic conditions related to obesity. *** Result of expanded coverage *** - Greater access to drugs like GLP-1 RA Wegovy and Zepbound that have shown good efficacy in helping patients lose weight, but at a steep price tag. - Expensive for taxpayers as the federal government expects to spend about $25 billion on weight loss drugs in Medicare over 10 years. - Will have complex impact on payers, which generally follow Medicare’s lead in coverage determinations, and would feel pressured to include GLP-1s in their plans despite cost concerns. #managedcare #medicine #pharmacy

It's time for #Medicare to cover #weightlossdrugs for those who need them most and address the growing U.S. #obesity epidemic. As the single largest #healthcare payer in this country, #CMS can have a huge impact on access to these #GLP1 #weightloss medications. https://lnkd.in/gqhxaHpJ #Wegovy #Zepbound #healthinsurance #drugprices #drugpricing #Oprah #prescriptiondrugs

I would be interested in getting feedback regarding the CMS 2026 proposed rule changes to cover anti-obesity drugs for Medicare and Medicaid members. The proposed rule applies only to those who have an obesity chronic condition and not those who are considered overweight. What are your thoughts? "CMS now proposes to reinterpret the statute to permit coverage of anti-obesity medications for the treatment of obesity when such drugs are indicated to reduce excess body weight and maintain weight reduction long-term for individuals with obesity. In so doing, we would be aligned with existing policies under which we permit Part D coverage for drugs that would otherwise be excluded when they are being used to treat certain specific diseases (e.g., drugs used to treat acquired immunodeficiency syndrome (AIDS) wasting and cachexia). CMS’ revised interpretation would recognize obesity to be a chronic disease based on changes in medical consensus. However, CMS would not consider that interpretation to extend to individuals who are overweight but do not have obesity as overweight is not considered a disease. Therefore, we would continue to exclude anti-obesity medications from Part D coverage when being used in individuals who are overweight but without obesity or another condition that is a medically accepted indication." https://lnkd.in/gfvd4KzW

🌟 Big News for NC Medicaid and Weight Loss Drugs! GLP-1s Now Covered! 🎉 North Carolina Medicaid is stepping up! Starting now, they're covering popular weight loss meds like Wegovy and Ozempic, which help fight obesity-related health issues. Affordable Access! 💸 Got $4? That’s all it costs for a copay. Now, everyone over 12 on Medicaid can access these life-changing meds without breaking the bank. Huge Health Benefits! ❤️ These meds aren't just about losing weight; they're proven fighters against serious stuff like heart attacks and diabetes. While this is great for Medicaid recipients, state employees aren’t covered under the same plan, sparking a debate about costs. It's a tough balance—ensuring access while managing a budget. 🤔 Don't lose hope if GLP-1s aren't accessible for you—there are other medications and lifestyle changes that can also effectively manage your health. Explore other options with us at Enara Health! Read more: https://lnkd.in/gyAKQ74T #HealthNews #Medicaid #Wegovy #Ozempic #NorthCarolina #Healthcare #Access #Obesity #Treatment #Type2Diabetes #Insurance #Coverage #Semaglutide #GLP1 Centers for Medicare & Medicaid Services Medicaid #NC #State #WeightLoss #Diabetes #Heart #Cardio #Disease #Weight #Lifestyle #Finance #Cost #Cardiology #Copay

On Tuesday, President Joe Biden proposed expanding Medicare and Medicaid to cover expensive obesity drugs, potentially affecting millions of senior citizens and low-income Americans while complicating future fiscal and healthcare priorities. The proposed rule is expected to increase access to obesity medications, such as Novo Nordisk's Wegovy (semaglutide) and Eli Lilly's Zepbound (tirzepatide), for an estimated 3.4 million Medicare and 4 million Medicaid beneficiaries. These drugs can cost up to $1000 per month without insurance, but some Medicare enrollees may see their out-of-pocket costs decrease by up to 95%, according to a White House fact sheet. #Obesity #Semaglutide #tirzepatide #NovoNordisk #EliLilly

Big News for Obesity Treatment Access! 💊 A new proposal could expand #Medicare and #Medicaid to cover costly anti-obesity drugs like #Wegovy and #Ozempic for 7.4 million Americans. Here’s what you need to know: 📉 Medicare enrollees could see out-of-pocket costs drop by up to 95%, making life-changing medications more accessible. 🩺Obesity would be officially recognized as a chronic condition, paving the way for broader treatment coverage. 💡 Medicaid coverage could ensure access for millions of low-income individuals. This could be huge! Not everyone can manage weight with lifestyle changes alone, and these meds offer crucial support for those who need it most. Let’s hope policy changes keep pushing forward so more people can access life-changing care and take control of their health. 💊✨ 🔗 Read more: https://lnkd.in/g4nra3Sw #Healthcare #Access #Health #Obesity #Weight #Medication #Lifestyle #Habits #Diet #Exercise #ObesityCare #GLP1 #Expansion #Coverage #Insurance #Biden #Medicine

If you want to understand the evolution of Medicare/Medicaid and the latest changes under the current administration, have a look at this article I researched and co-wrote with my colleagues at the UAB Lister Hill Center for Health Policy: https://lnkd.in/deG4C9Bt #freelancewriter #medicare #medicaid #drugprices #healthpolicy

This just in: The Biden-Harris Administration is making strides to reduce prescription drug expenses by suggesting broader coverage for Anti-Obesity Medications (AOMs) under Medicare and Medicaid for Americans. At present, Medicare and Medicaid already cater to AOMs for specific conditions such as diabetes. The new proposal aims to extend the reach of these cutting-edge medications to combat obesity, a widely acknowledged disease. This initiative is set to benefit approximately 3.4 million Americans under Medicare and approximately 4 million adult Medicaid enrollees. The expanded Medicare coverage could potentially slash out-of-pocket expenses for prescription drugs by up to 95% for certain beneficiaries. Rebellis Group is here to help. Reach out to [email protected] https://lnkd.in/gUG8c5Tt