TL/DR –
The Centers for Medicare and Medicaid Services (CMS) is considering a change that would require insurance companies to cover obesity drugs. Despite the potential significant impact of this change, insurers would still have tools to restrict coverage, such as formulary tiers. The shift would open up a market that has been relatively slow to cover the approximate $16,000-a-year new class of medications.
ACA Plans to Cover Obesity and Infertility Drugs?
Pharmaceutical companies are capitalizing on the escalating demand for new obesity drugs and may soon receive government assistance. CMS is contemplating a change that mandates insurance companies to cover weight loss medications, potentially impacting over 20 million Americans.
This minor modification could drastically alter the coverage landscape. Currently, Medicare does not cover weight loss drugs, so ACA plans are not obligated to either. However, if ACA’s drug classification system is replaced with a non-Medicare-based one, it could mandate coverage for obesity and infertility treatments.
Insurance companies can still limit coverage through formulary tiers. But this change could potentially stimulate a market that has been slow to start covering these new medications, costing approximately $16,000 annually. Read more about the proposal here.
HHS Accused of Non-Cooperation in COVID-19 Investigation
The lack of cooperation from HHS with a congressional committee investigating the Covid-19 pandemic is “unacceptable” and could require “compulsory” testimonies, warns Brad Wenstrup (R-Ohio), Chairman on pandemic oversight, in a recent letter.
This letter follows two weeks after a top HHS official testified before his committee, drawing criticism from Republicans who accuse the agency of withholding and delaying essential documents about Covid-19’s origins and containment measures. Wenstrup listed 12 instances where the committee sought this information and is demanding details on how these requests were processed.
Surprise Medical Bill Ban Increases Other Costs
The federal government’s ban on surprise medical bills is protecting patients from unexpected costs, but it’s raising costs elsewhere, stirring up discontent among insurers.
The new progress report from the Biden administration reveals that in over 80% of payment disputes, the resolved amount was more than the median in-network rate for that service. This has led to policymakers warning about unintended consequences.
Medicare Advantage Enrolment Reaches 33 Million
About 33.4 million people enrolled in Medicare Advantage plans as of 2024, reflecting steady growth for the taxpayer-funded program. The data indicates a shift in America’s Medicare program towards a more privatized version. Despite changes introduced to Medicare Advantage for 2024 that were opposed by the health insurance industry, the program’s growth remains unhindered.
Experts caution that the data has some caveats. Learn more about the Medicare Advantage trends here.
Recommended Reads
- HHS fills key vaccine advisory panel slots, STAT
- Opinion: The complicated connections between weight loss drugs and mental health, STAT
—
Read More Health & Wellness News ; US News