Reimbursement News, In Brief
Executive Summary
News round-up includes Medicare Part B drug coverage reforms, private health plan restrictions on access to drugs for rare disease, a status check on CMS’ efforts to launch the insurance exchanges, a new public forum for former CMS administrator Berwick and Medicare claims data transparency.
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GLP-1 Coverage Restrictions In Medicare Part D Surge As Demand For Obesity Drugs Grows
A major shift from unfettered coverage to prior authorizations was recorded by MMIT over the past year for the leading GLP-1/GIP agonist diabetes drugs. Public interest in using the drugs off label for weight loss drove the change.
Medicare Reimbursement For Part B Drugs Is 48% Above 340B Prices To Hospitals, MedPAC Finds
New study updates past commission analyses and highlights the significant margin between Medicare payments for drugs and the prices paid by 340B-eligible providers.
Xtandi Pricing and Patents: Alternatives To March-In Urged To Lower Medicare, Medicaid Costs
The timing of the request, with Xtandi’s loss of exclusivity on the horizon, could be explained by the concern that a change in the US presidential administration in 2025 may limit the prospects for near-term relief.