Obesity Drug Coverage In ACA Plans May Expand With Shift In Treatment Classification Standard
Current drug classification standard was originally designed for the Medicare Part D program, which does not cover obesity drugs.
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The problem that obesity drugs are not covered by Medicare Part D might be alleviated if Lilly’s weight loss candidate is also cleared for indications that are reimbursed. Policy and treatment experts discuss the importance of proving obesity drugs can lower federal government health care spending during a recent discussion convened by the Institute for Clinical and Economic Review.
Although the rule does not adopt the many drug access protections requested by drug industry stakeholders, it does promise forthcoming guidance regarding HHS expectations for the formulary exceptions process that should be followed by exchange plans.
Packaging for such products reflects ‘unique circumstances’ that should exempt them from the rebates on discarded drugs otherwise required by the policy, stakeholders tell CMS at a ‘town hall’ forum.