Higher Medicare spending will result from CMS footing the bill for the expanded GLP-1 obesity drug coverage under the Bridge program; Part D plans will bear no costs for it. The longer duration of the GLP-1 Bridge is good news for beneficiaries but raises concerns re: higher Medicare spending.
CMS said the BALANCE model wouldn't launch in 2027 without the participation of plans covering at least 80% of enrollees. Given the potential uptake in use of GLP-1s under the model, it seems many plans were reluctant to participate, even with the promise of access to discounted prices for GLP-1s.
CMS has just announced that the BALANCE program for GLP-1 coverage will not launch in Medicare Part D in 2027 and the BRIDGE program will be extended through 2027 (it was set to run from July-Dec 2026). This could add billions to Medicare spending in 2027. www.kff.org/quick-take/w...
Today, April 20, is the deadline for Medicare Part D plans to apply to participate in the BALANCE model for Medicare coverage of GLP-1 obesity drugs. Without robust plan participation, the model will not move forward in 2027. See our @kff.org brief for details. www.kff.org/medicare/wha...
Medicare's State Health Insurance Assistance programs are still up and running!
(For those who might not know about the role of SHIPs in helping people with Medicare navigate their coverage options, our new @KFF brief explains) www.kff.org/medicare/the...
CMS is shutting down the National Training Program, whose mission is "to communicate Medicare and other CMS-program information that...can be used to effectively train the public." The site will be discontinued Oct 15, the first day of Medicare 2026 open enrollment cmsnationaltrainingprogram.cms.gov
Requiring Medicare to cover drugs to treat obesity would have increased Medicare spending by $25 billion over 10 years, but would also have helped millions of people with Medicare who might benefit from these drugs but can’t afford them due to their high price tags. www.kff.org/policy-watch...
Spending on anti-obesity drugs has skyrocketed in recent years, even though they are now only covered under Medicare for uses other than obesity. One of these drugs, Ozempic (semaglutide), was recently selected for Medicare drug price negotiation, with total gross spending of $14 billion in 2024.
🚨CMS just announced that Medicare will NOT move forward with a proposal to require coverage of drugs used to treat obesity. This proposal was issued at the end of the Biden administration but it was up to the Trump administration to finalize, or not. www.cms.gov/newsroom/fac...
CMS makes it official: the Innovation Center will not move forward with the Medicare $2 drug list model, a Biden administration plan to test whether improved access to low-cost drugs would improve health outcomes, which Trump moved to cancel on day one of his second term. www.cms.gov/newsroom/fac...
How workforce reductions at the Social Security Administration will affect people is unknown, but could make it harder for people to get connected to benefits they might qualify for through paperwork delays or other hurdles, which would in turn affect coverage through Medicare and/or Medicaid.
Social Security is also a pathway to health coverage for people with disabilities, who can qualify for Medicare after receiving disability benefits for two years, or Medicaid for people receiving Supplemental Security Income, as our @kff.org brief explains. www.kff.org/medicare/iss...
With news that Social Security is implementing major workforce reductions, it's worth noting that the agency plays a big role in helping people enroll in Medicare by processing applications for Part A and B, as well as for the Part D drug benefit's extra help program. www.kff.org/faqs/medicar...
The outgoing Biden administration has proposed this change, but we don’t know yet whether the incoming Trump administration will decide to finalize this proposal.
The outcome matters not just for the people on Medicare who are currently using these drugs for diabetes and cardiovascular disease risk reduction, but those who would take this drug in the future if Medicare coverage expands to cover anti-obesity drugs, which is currently prohibited.
🚨 Round 2 of Medicare's drug price negotiation program just kicked off. The popular diabetes and obesity drugs Ozempic and Wegovy are at the top of the list. Medicare price negotiation could play a key role in increasing affordability and access to these drugs.
www.kff.org/quick-take/w...
This proposal would also expand coverage under state Medicaid programs, which currently can but aren't *required* to cover drugs to treat obesity. Our new policy watch explains the implications of this proposed change for Medicare and Medicaid coverage and costs. www.kff.org/policy-watch...
It's important to note that this is a proposed rule that will be finalized under the incoming Trump administration. Will the new administration finalize the change as proposed, try to modify it, or pull back altogether on this popular idea of allowing Medicare to cover these drugs? Time will tell.
This would be a big deal for millions of people with obesity on Medicare who currently have to pay the full price of these drugs out of pocket, if they can even afford to - unless they also have another condition where Medicare is already authorized to cover these drugs, like for type 2 diabetes.
The Biden administration has proposed to allow Medicare to cover anti-obesity drugs, which is currently prohibited by law. The proposals hinges on reinterpreting the statutory language to allow coverage when these drugs are used to treat obesity, which is now commonly regarded as a disease.
With 2 weeks left in #Medicare open enrollment, people in stand-alone #PartD drug plans are facing a lot of changes in the market, with fewer choices overall and higher premiums for some plans but lower premiums for others. More details in our analysis of the 2025 market: www.kff.org/medicare/iss...
For Medicare D, the law defines what drugs will and won't be covered >> drugs and vaccines that are approved by the Food & Drug Administration (with a few exceptions, like anti-obesity drugs).
So Congress would need to change the law in order to change what drugs and vaccines Medicare covers.
NEW @kff.org calculator tool shows how much more ACA enrollees will pay if enhanced subsidies to expire
www.kff.org/interactive/...
It's also worth keeping an eye on the several lawsuits that have been filed against the negotiation program by drug companies and the pharma industry, and how vigorously HHS under President-elect Trump will continue to defend the program in court.
It is unclear what direction the incoming Trump administration might choose to take with respect to the negotiation program, but it certainly seems possible that the approach to implementation in 2025 and beyond may differ from that which was laid out in CMS’s most recent guidance.
A key deadline for Medicare's drug price negotiation program will come soon after President-elect Trump is inaugurated: releasing the list of up to 15 drugs selected for round 2 of negotiation by Feb 1, 2025. Our updated FAQs has a timeline of key activities to watch. www.kff.org/medicare/iss...