Health Plan Weekly

Medicare, Medicaid Coverage of Obesity Drugs Would Add $40B in Government Spending

  • Nov 27
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    Nov 27, 2024

    Medicare Part D and Medicaid coverage of anti-obesity medications would increase federal and state spending by $40 billion over 10 years, CMS estimated in a proposed rule released on Nov. 26, even though Part D plans could define the disease for coverage decisions.

    The policy long sought by drug manufacturers and patient groups is part of the 2026 Policy and Technical Changes to the Medicare Advantage and Medicare Part D Programs proposed rule.

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    • Cathy Kelly

    Cathy is a senior writer with Pink Sheet and has covered U.S. regulation and reimbursement policy for the biopharma industry since 2004, starting with the establishment of the Medicare Part D program. Since then, she has written extensively about developments in all major sectors of the U.S. insurance market (Medicare, Medicaid and commercial plans). She has covered key legislation affecting biopharma, including the Medicare Prescription Drug, Improvement, and Modernization Act which created Part D, health care reform under President Obama, and the Inflation Reduction Act. She has closely followed the increasing influence of pharmacy benefit managers and their use of formulary negotiations and rebates to control pricing. Cathy also has covered developments in health technology assessments and has monitored industry progress on novel drug contracting that reflects value-based pricing.

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