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Can Medicare Cover Obesity Drugs Without Congressional Action? Industry Builds Its Case

 
• By Sarah Karlin-Smith

Obesity drug ≠ weight-loss drug, a new Pfizer-funded white paper argues in laying out a legal case for Part D coverage of obesity medicines even without legislation. Advocates hope forthcoming updates to a 2007 FDA guidance on weight management drugs will bolster the case for coverage.

Obesity coverage
Pfizer-commissioned report says CMS can reinterpret existing law to permit coverage of new anti-obesity medicines in Medicare Part D. • Source: Nielsen Hobbs; the Pink Sheet | Shutterstock images

Current obesity medications are distinct from treatments intended solely for weight loss and thus Medicare is free to cover such medicines in Part D if they choose, a new white paper commissioned by Pfizer Inc. argues.

The paper flips on its head a commonly held assumption that it is Congress that is standing in the way of broader Medicare coverage of GLP-1 agonists, the popular type 2 diabetes products turned weight-loss drugs, due to a ban on coverage of drugs used for

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New Guidance Suggests SubQ Keytruda, Opdivo Formulations May Not Avoid Medicare Negotiations

 
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New draft guidance on the third cycle of Medicare drug price negotiations goes against Merck and BMS expectations for their cancer drugs. The guidance also tackles Part B and renegotiated prices for the first time.

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