���ϳԹ���

The Biden administration plans to require Medicare and Medicaid to offer coverage of weight loss medications for patients seeking to treat obesity. The new rule, which was proposed by the administration on Tuesday, would dramatically expand access to anti-obesity medications like Wegovy, Ozempic and Mounjaro. Until now, Medicare and Medicaid have only provided insurance coverage for these drugs when they are used to treat conditions like diabetes. (Bush, 11/26)

In a statement, Biden administration officials said they had reinterpreted their long-standing rules blocking coverage for weight-loss drugs with a newfound recognition that obesity is “a chronic disease based on changes in medical consensus.” The new rules would apply only to people who are obese. Beneficiaries who are overweight would not be eligible unless they have another condition such as diabetes that qualifies for weight-loss drugs. The Trump administration is not required to finalize any or all of the proposal. Robert F. Kennedy Jr. — whom Trump has selected to be the next HHS secretary, if confirmed by the Senate — is an avowed critic of weight-loss drugs such as Ozempic, which he has blamed for obfuscating the root causes of poor health in America. (Diamond, 11/26)

A popular bipartisan bill to curb the use of prior authorization in Medicare Advantage has everything it needs to pass Congress this year, except that it probably won't, and lawmakers who would like to move it are not sure it ever will. Enthusiastic senators and representatives rolled out the Improving Seniors’ Timely Access to Care Act of 2024 last summer, promising to increase transparency in Medicare Advantage prior authorization requests and mandate speedier responses. (McAuliff, 11/25)

When Gwen Williams’ mother was dying, taking her to an in-person appointment to get more medicine seemed impossible. So Williams made a telehealth appointment with the doctor—a video call. It was that easy. “Her comfort was paramount,” Williams, who lives in Minnesota, recounts. “My mother wasn’t conscious during the visit, but [the doctor] was able to see her and was able to get the hospice medications and everything refilled.” ... The fact that Medicare will abruptly cut off that coverage for most specialties on January 1—barely a month away—Williams said, “just blows my mind.” (Metraux, 11/25)

Medicare is paying wildly different prices for the same drug, even for people insured under the same plan. As a result, people covered by Medicare can be on the hook for thousands of dollars in additional out-of-pocket costs depending on where they live and which drug plan they choose. Take commonly used generic versions of prostate-cancer treatment Zytiga. They have more than 2,200 prices in Medicare drug plans. The generics ring in at roughly $815 a month in northern Michigan, about half of what they cost in suburban Detroit, while jumping to $3,356 in a county along Lake Michigan, according to a recent analysis of Medicare data. (Hopkins and Ulick, 11/26)

Centene is joining the ranks of Medicare Advantage insurers cutting pay to marketers that direct new customers their way. The insurer notified brokers and agents on Monday that it will no longer compensate them for enrolling new members into eight Medicare Advantage plans sold in New York state and Washington state beginning Wednesday, said Betsy Seals, co-founder and CEO of Rebellis Group, a Medicare consulting firm. (Tepper, 11/25)

���ϳԹ��� News: Florida’s Deloitte-Run Computer System Cut Off New Moms Entitled To Medicaid

In mid-May, Mandi Rokx had a 3-month-old baby and a letter from a Florida agency warning that they both would be cut from Medicaid, the health insurance program for people with low incomes or disabilities. Under a Florida law passed in 2021, Rokx was supposed to receive 12 months of continuous coverage after giving birth. But the letter from Florida’s Department of Children and Families said their coverage would end May 31. The explanation: “You failed to complete or follow through with your Medicaid renewal.” (Chang and Liss, 11/26)