News Briefs: Proposed Rule Would Tweak Medicare Advantage Regs
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Nov 27, 2024
CMS on Nov. 26 issued a proposed rule that would make various changes to the regulations governing Medicare Advantage plans, as well as increase access to anti-obesity medications for Medicare and Medicaid beneficiaries. Starting in 2026, CMS is proposing to reinterpret the Medicare statute “to no longer exclude anti-obesity medications for the treatment of obesity from coverage under Medicare Part D and to require Medicaid programs to cover these medications when used to treat obesity.” If finalized by the Trump administration, the rule would greatly increase Medicare and Medicaid beneficiaries’ access to FDA-approved weight loss medications such as Wegovy (semaglutide) and Zepbound (tirzepatide). The rule would also limit the use of prior authorization and internal coverage criteria in Medicare Advantage and Part D plans as well as “increase guardrails on the use of artificial intelligence to protect access to health services.” In addition, the agency is seeking to make upgrades to the Medicare Plan Finder website, including requiring MA organizations to make their entire provider directory available and making it easier for consumers to compare MA plans. Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said in a Nov. 26 statement that “we are deeply concerned with the proposed coverage expansion of weight loss drugs in Medicare and Medicaid” and added “the proposed expansion is irresponsible without further analysis and stakeholder engagement.” Read more
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