‘Essential’ Drug Coverage Including Obesity Treatments Make Sense For ACA Plans, CMS Says

The Centers for Medicare and Medicaid Services is leaning toward changing the drug classification standard for private insurance plans serving the individual and small group markets in a way that could encourage broader coverage of weight loss drugs. But the agency wants more information about the cost of coverage and how insurers would manage it before making the change.

CMS discussed switching the drug classification standard in its proposed 2025 Notice of Benefit and Payment Parameters for plans governed by the Affordable Care Act, released on 15 November. The proposed rule also addressed restrictions on the use of copay maximizers by ACA plans