Why Not Mandatory GLP-1s In Medicare For Obesity?
A Health Affairs Forefront Blog argues that GLP-1 coverage for obesity should be made mandatory. I have given great credit to the Trump administration for reducing drug prices, including with GLP-1s. But the proposed BALANCE reform model failed to attract enough health plans in the voluntary program. The government funding and risk mitigation just did not solve the fundamental risk problem, especially for standalone Part D (PDP) plans. Instead, Trump healthcare officials are proposing the BRIDGE program through 12/31/2027 to have the government cover the cost of such drugs for obesity.
The authors argue that voluntary BALANCE failed to attract plans so other options exist:
- Stripping intellectual property rights from drug makers, which obviously would be challenged.
- Making coverage of GLP-1s for obesity available in Medicare.
- Make the BALANCE program mandatory.
(Article may require a subscription.)
#glp1s #weightlossdrugs #drugpricing #medicare #medicareadvantage #partd #pdp
Commonwealth: One In Five Hit With Coverage Denials
The Commonwealth Fund released its 2025 Affordability Survey, which found that one in five adults said they or a family member had a medical service denied in the past year. About 8% of coverage denials were due to denied claims, while 13% were due to prior authorization denials. One percent of the denied services fell into both categories.
Additional article: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/121606
#priorauthorization #claimsdenials #healthplans #coverage
NSA Rule May Lead To More Provider Awards
A Biden-era draft rule was just finalized by the Trump administration, and it purports to reform No Surprises Act (NSA) disputes. While the rule could limit erroneous filings in the long term, some are now arguing the rule could lead to more provider disputes and awards in the near term. They argue the lower fees will incentivize more claims by providers.
(Article may require a subscription.)
#nosurprisesact #transparency #pricetransparency
https://www.modernhealthcare.com/politics-regulation/mh-no-surprises-act-rule-idr-arbitration
— Marc S. Ryan
