1. Pink Sheet
  2. >>Market Access

Obesity Drugs Cost Concerns Not Yet Impacting HHS Risk Adjustment Models

 
• By Cathy Kelly

Individual and small group plans in the commercial insurance market are not seeing ‘a large enough change in clinical indications or practice patterns to warrant a change to the current mapping of GLP-1 drugs,’ final rule states.

weight-scale-with-a-tight-belt
Insurance plans worry they will need to tighten their belts because of GLP-1 spending. • Source: Shutterstock

The final HHS Notice of Benefit and Payment Parameters for 2025 is not offering any immediate relief to Individual and small group plans in the commercial insurance market worried about increasing costs from GLP-1 drugs.

In response to comments received urging a modifications in the HHS risk adjustment models used by plans to calculate risk scores that would recognize the increasing cost of covering GLP-1 drugs, the Centers for Medicare and Medicaid Services said in the

Read the full article – start your free trial today!

Join thousands of industry professionals who rely on Pink Sheet for daily insights

  • Start your 7-day free trial
  • Explore trusted news, analysis, and insights
  • Access comprehensive global coverage
  • Enjoy instant access – no credit card required
Start Free Trial

Already a subscriber?

More from Market Access

More from Pink Sheet

EU Shaping Biotech Act To Unleash SME Potential

 
• By Neena Brizmohun

European companies, in particular small and midsize enterprises, spin-offs and start-ups have a hard time expanding within the single market “because of a complex regulatory framework that is perceived as slow and burdensome,” according to the European Commission.

New EU Filings

 
• By Neena Brizmohun

Brensocatib, Insmed's investigational treatment for non-cystic fibrosis bronchiectasis, is among the latest products that have been filed for review by the European Medicines Agency for potential EU marketing approval.

‘Tectonic’ Arkansas PBM Legislation May Upend Industry

 
• By Tim Casey

Industry will fight hard to prevent other states or the federal government from adopting measures similar to Arkansas' law preventing PBMs from owning pharmacies.