Medicare Part D and Medicaid coverage of anti-obesity medications would increase federal and state spending by $40bn over 10 years, the Centers for Medicare and Medicaid Services estimated in a proposed rule released 26 November, even though Part D plans could define the disease for coverage decisions.
Medicare, Medicaid Coverage Of Obesity Drugs Would Add $40bn In Government Spending
The proposal states that Part D plans could define "obesity" for coverage determination, but CMS said overly restrictive criteria would be inconsistent with formulary review requirements and step-therapy would not be allowed.
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