Healthcare Finance News’ Post

Medicare weight loss drug coverage could cost $34 billion

House panel to consider some Medicare coverage for weight-loss drugs A proposal that would allow limited Medicare coverage of weight loss drugs such as Zepbound and Wegovy for individuals with obesity will be considered by the House Ways and Means Committee at a markup session this week. The amendment to the Treat and Reduce Obesity Act of 2023 would limit Medicare coverage to beneficiaries with obesity who were prescribed the weight-loss drugs for at least one year before switching to Medicare. https://lnkd.in/eQpBvE4s

Plan sponsors beware. GLP-1s for weight loss may not be all they’re cracked up to be. Medical claims analysis reveals: 30% of patients discontinued weight loss treatment after four weeks due to intolerability of the medications Nearly six in ten patients quit using GLP-1 drugs before reaching clinically meaningful health benefit. To ensure proper utilization and management, be aware of the risks and build appropriate safeguards into your plan. 

Prescription drug costs are distressing Americans and causing financial hardship when they go to the pharmacy to pick up their medications. Americans are being forced to decide between medication or groceries. Pharmacy benefit managers original purpose was to help lower the costs of medication but this has never materialized. Access For Health https://lnkd.in/eYH_NHzr provides $0 copay 24/7 nationwide virtual physician visits including over 3,000 $0 copay most commonly prescribed acute, maintenance and mental health prescriptions at over 70,000 nationwide. https://lnkd.in/eYH_NHzr

It’s been a wild ride to watch the GLP-1 trend over the last two decades—from a journal club on Byetta as a P4 to jumping on board with the once weekly options as a clinician and diabetes educator to Ozempic becoming a household medication name. Becker’s article today highlight the impact GLP-1s are having on the US healthcare system. TL;DR - A report from Sen. Bernie Sanders warns that high prices for weight loss drugs like Ozempic and Wegovy could financially strain the U.S. healthcare system. Medicare spending on these drugs surged from $57 million in 2018 to $5.7 billion in 2022. If widely used, costs could reach $411 billion annually for Americans with obesity, and $166 billion for Medicare and Medicaid. Lowering U.S. prices to international levels could save billions. While some insurers and states are covering these drugs, others are dropping them due to high costs. The whole article here - https://lnkd.in/gV-zyVyQ

If you're in a Medicare drug-benefit plan, you've generally had to pay out of pocket to get anti-obesity medications like Wegovy because the law creating the Medicare benefit excluded coverage of weight-loss drugs. Their list prices can top $1,000 a month. That's starting to change - this week, the Medicare agency told Part D plans they may cover obesity drugs for additional, medically accepted uses. As in, paying for Wegovy for its new FDA-approved use of cutting risk of heart attacks and strokes in people with cardiovascular disease (and who are also either obese or overweight). But it's a limited expansion - the drugs still won't be covered if they're used for weight loss alone in people without heart disease. What do you think? Should Part D plans start to pay for these drugs? Should Congress change the law to allow for broad coverage for their main use, to lower and maintain weight?

💉 The Truth Behind Insulin Prices—And What Could Change 💊 For millions of people, insulin is a life-saving necessity, yet it’s been priced out of reach for far too long. Even with the recent cap of $35/month for many, the question remains: how did insulin become so expensive? The Federal Trade Commission (FTC) just launched a major lawsuit against the biggest pharmacy benefit managers (PBMs)—CVS Health's Caremark Rx, Cigna's Express Scripts, and United Health Group's OptumRx—alleging these middlemen drove up insulin prices to increase their own profits through a complex and opaque rebate system. 📈 This suit has the potential to bring more transparency to a system that has forced many patients to ration their insulin—putting their lives at risk. 🚨 What do you think? Will this FTC lawsuit change the game for drug pricing? Share your thoughts and experiences below! 🔗 Learn more about the complexities behind insulin pricing in the full article: #InsulinCosts #HealthcareTransparency #PharmaReform #PBMs #DiabetesCare #NiHowdy #NetZeroPrescriptionCosts

The recent development of GLP-1s, weight-loss drugs that work by suppressing patients’ appetites, could have a huge potential impact, given that 40% of US adults are considered obese. These drugs could improve the lives of 85 million Americans with pre-existing cardiovascular disease. Competition is sure to follow, but several major players already have FDA-approved drugs for Type 2 diabetes and weight loss. These market-changing developments will have ripple effects on the health care industry and beyond. While GLP-1s still have hurdles to clear, including questions about side effects, administration, and insurance coverage, a different healthcare sector will emerge. For more, click here: https://lnkd.in/eb5Gk_MS #weightloss #rippleeffect #disruption #drugdevelopment #marketchanging #insurance #healthcareindustry #improvelives

🌟 Breaking News: Anti-obesity Medications Taking Off in the U.S.! 🇺🇸 Recent data reveals that Kentucky leads the way with the highest rate of GLP-1 prescriptions, with roughly 21 prescriptions per 1000 people dispensed in 2023. GLP-1 agonists, known for their role in battling obesity and diabetes, are making waves in several Southern states, including Louisiana and Mississippi. Why does it matter? These statistics provide insight into the demand for game-changing drugs like Ozempic and Wegovy across the United States. The states with the highest prescription rates are often the ones with higher rates of diabetes and obesity, indicating a vital need for these medicines. Kentucky tops the list, followed by West Virginia, Alaska, Mississippi, and Louisiana. On the other hand, Rhode Island and Massachusetts have the lowest prescription rates. This data is based on 1.9 billion claims from private insurers, Medicare, and Medicaid. It includes medications like Ozempic, Wegovy, Mounjaro, and Zepbound, although it doesn't specify whether they are prescribed for obesity or diabetes. While Hollywood may be buzzing about these drugs, the data might not capture prescriptions paid for in cash, which can be quite expensive. Stay tuned for more updates on the evolving landscape of weight-loss medications! 💊📈 #HealthNews #WeightLoss #ObesityMedications