Medicare and Medicaid Cover GLP-1s For Disease States Other Than Obesity
The Hill has a good article explaining what the coverage of GLP-1s is in Medicare and Medicaid.
Generally, GLP-1s are covered for disease states such as diabetes and cardiovascular diseases, but not for obesity alone. In the commercial world, some employers cover the drugs for obesity alone.
In addition, drugmakers Eli Lilly and Novo Nordisk market their GLP-1 drugs under different names. Here is the skinny so to speak. The brand drug makers are looking to expand these drugs to other disease states.
Novo Nordisk:
Ozempic – for treatment of diabetes
Wegovy – for weight loss and cardiovascular disease
Eli Lilly:
Mounjaro – for treatment of diabetes
Zepbound – for weight loss and certain sleep apnea.
#branddrugmakers #drugpricing #glp1s #weightlossdrugs
https://thehill.com/policy/healthcare/5290997-medicare-medicaid-coverage-weight-loss-drugs
CVS Being Sued Over Alleged Fraud
Four state attorneys general are suing CVS Health and its pharmacies for allegedly submitting false and fraudulent claims to state Medicaid programs. The lawyers argue CVS used third-party discount cards to get around giving Medicaid a lower usual & customary price.
Health plans sued CVS in 2020 for charging lower prices for generic drugs through customer discount programs as well.
#cvshealth #drugpricing #pbms
Service Units Boosting Major Healthcare Companies
A good article showing how the big integrated healthcare companies with insurers are being bolstered by service units as insurance units suffer. Financial performance is much better at these units, although UnitedHealth Group did report some erosion on services as well. Not all of the big seven healthcare companies have services units and some are more pure insurers. While Big Healthcare says vertical integration saves money and delivers better care, Congress and regulators are looking at the antitrust implications.
(Article may require a subscription.)
#healthplans #margins
https://www.modernhealthcare.com/finance/optum-evernorth-health-services-centerwell-growth
Treasury Notified That Debt Limit Will Be Reached In Mid-July
Treasury Secretary Scott Bessent notified Congress that the nation’s debt limit ceiling has to be raised by mid-July to keep the federal government from defaulting on its more than $36 trillion debt.
The problem is that the GOP caucus is far apart in terms of agreeing on a budget reconciliation bill. Moderates want smaller cuts and conservatives greater ones. Conservatives are unlikely to support a free-standing debt limit increase.
The suspension of the debt limit ended on January 2, 2025.
#congress #trump #debtlimit #budgetreconciliation
https://thehill.com/homenews/administration/5293011-bessent-congress-debt-limit
— Marc S. Ryan
