Medicare Update: New GLP-1 Program Delayed
Summary
A planned Medicare pilot program called BALANCE to expand coverage of weight-loss drugs known as GLP-1s has been delayed until at least 2027. The delay follows concerns from insurers about high costs and uncertainty over how the program would work.Key Facts
- The BALANCE pilot program was created by the Centers for Medicare & Medicaid Services (CMS).
- GLP-1 drugs are approved mainly for Type 2 diabetes but are increasingly used for weight loss.
- Insurers worried about the financial risks and unclear rules around eligibility and costs.
- Major insurers like UnitedHealthcare, CVS, and Eli Lilly chose not to participate.
- GLP-1 drugs can cost thousands of dollars per year per patient.
- Medicare currently limits coverage of weight-loss drugs unless Congress makes specific exceptions.
- The delay means Medicare beneficiaries will largely continue paying out of pocket for GLP-1 drugs used for weight loss.
- Permanent coverage changes would likely require new laws from Congress and further CMS guidance.
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