Study Shows Proliferation Of GLP-1s
A new study finds that the number of people prescribed GLP-1 drugs for weight management has skyrocketed over the past five years. FAIR Health’s study finds that just over 2% of adults in the U.S. took a GLP-1 to treat obesity or being overweight in 2024, up from just 0.3% in 2019. For those not diabetic, the percent of such adults increased from 0.03% in 2019 to 0.67% in 2019, or 1,960.9%.
While big national providers have sought to expand GLP-1 coverage while de-risking impacts, other plans are discontinuing coverage due to surging costs. A number of Blues are discontinuing obesity-only GLP-1 coverage.
In other news, compounders continue filling compounded GLP-1 drugs by arguing individual formulations are allowable.
Additional article: https://www.modernhealthcare.com/insurance/bcbs-plans-michigan-massachusetts-glp1-coverage and https://www.healthcaredive.com/news/glp1-obesity-weight-loss-adoption-fair-health/748963/ and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/telehealth-companies-use-loophole-continue-glp-1-sales
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#weightlossdrugs #glp1s #healthplans #pbms #drugpricing #branddrugmakers
MA Industry Divided On Risk Adjustment Audits
The Medicare Advantage (MA) industry is very split on the Centers for Medicare and Medicaid Services’ (CMS) proposal to accelerate risk adjustment audits so each plan is reviewed each year. Insurance lobby AHIP and the Better Medicare Alliance favor the approach, with some caution. But the Association of Community Health Plans (ACHP) is opposed.
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#medicareadvantage #riskadjustment #overpayments
https://insidehealthpolicy.com/daily-news/stakeholders-mixed-cms-medicare-advantage-plan-audits
Will Senate Really Change Reconciliation Bill Much?
An aide for Speaker Mike Johnson, R-LA) says he does not expect major changes in the Senate to the budget reconciliation bill. But a schism is emerging in the upper chamber between moderates and pragmatic conservatives who want to slim down cuts and conservatives who want to add to them. Sen. Josh Hawley, R-MO, is merging as the staunchest of defenders of Medicaid. Hawley argues people in his red state would suffer if the bill proceeds as is.
Additional articles: https://thehill.com/homenews/senate/5321346-gop-taxes-budget-bill-senate/?tbref=hp and https://thehill.com/policy/healthcare/5320629-josh-hawley-medicaid-reform/
#budgetreconciliation #trump #congress #medicaid #coverage
https://thehill.com/homenews/senate/5320674-senate-republicans-trump-bill-debate
— Marc S. Ryan
