Summary
Eli Lilly announced changes to Medicare coverage for certain weight-loss drugs, allowing some costs to exceed the usual $50 monthly cap. The Centers for Medicare and Medicaid Services (CMS) is implementing a new program to lower costs for these drugs, but some basic plans may not fully comply with the cap.
Key Facts
- Eli Lilly says some Medicare beneficiaries might pay more than the typical $50 monthly cap for weight-loss drugs under a new federal model.
- The new coverage model by CMS aims to expand and standardize coverage for GLP-1 drugs, which treat obesity and diabetes, to lower patient costs.
- Most participating Medicare plans will follow the $50 out-of-pocket limit, but a few basic plans might not.
- Eli Lilly plans to educate patients and doctors about options to lower out-of-pocket costs.
- Lilly’s GLP-1 treatments will be available through Medicare Part D plans starting January 1, 2027.
- Medicare Part D is managed by private insurers and helps cover outpatient prescription costs.
- Without insurance, GLP-1 drugs can cost patients more than $1,000 per month.
