Health


“Inside the $440,000 Surgery: When Medicine Meets Money and Arbitration”

“Inside the $440,000 Surgery: When Medicine Meets Money and Arbitration”

Emblem Health sued plastic surgeon Norman Rowe and related entities in federal court in New…

By
Misbah Jogyat
WASHINGTON: UnitedHealth has warned that the Trump administration’s planned Medicare obesity-drug pilot faces “notable challenges,” casting doubt over how smoothly the program can move ahead if major insurers stay cautious. Recent market reporting said the model depends heavily on participation from Medicare drug plans that cover most Part D enrollees, which makes the stance of large insurers especially important. The concern centers on a broader CMS effort to expand access to GLP-1 weight-loss medicines for seniors. Under CMS’s published framework, the longer-term BALANCE Model would begin in Medicare Part D in January 2027, while a temporary Medicare GLP-1 Bridge is designed to start earlier and give eligible beneficiaries short-term access before that main model begins. What makes this a little more complicated is that the short-term bridge and the longer pilot are not the same thing. CMS says the Medicare GLP-1 Bridge operates outside the normal Part D coverage and payment flow, meaning Part D sponsors are not directly involved in that bridge arrangement. In other words, insurer participation is a much bigger issue for the 2027 BALANCE rollout than for the bridge itself. That distinction matters because investors and drugmakers are watching this closely. Reports said shares of obesity-drug makers fell after UnitedHealth’s comments, largely because Medicare coverage is seen as a huge growth opportunity for drugs such as Wegovy and Zepbound. If major insurers hesitate, the program could struggle to achieve the scale CMS appears to want. There is already some evidence of resistance. MarketWatch reported that CVS Health has opted out, while UnitedHealth is still evaluating the structure and discussing possible changes with Medicare officials. That does not mean the program is dead, not yet anyway, but it does suggest the administration may need to revise the design or sweeten the terms if it wants broader insurer buy-in. The bigger backdrop here is cost. Medicare has long been wary of broad obesity-drug coverage because GLP-1 therapies are expensive and potentially involve very large patient populations. Earlier policy debates around these drugs were shaped by concerns that wide coverage could drive up federal spending sharply, even as supporters argued the medicines could reduce longer-term health costs tied to obesity. So the headline problem for CMS is pretty straightforward: it has created a short-term bridge that can move without direct Part D plan involvement, but the more ambitious long-term Medicare model still appears to need insurers on board. UnitedHealth’s warning does not shut the door, but it does signal that one of the industry’s biggest players thinks the current setup may not be ready for easy launch.

UnitedHealth raises red flags over Medicare obesity-drug pilot

WASHINGTON: UnitedHealth has warned that the Trump administration’s planned Medicare obesity-drug pilot faces “notable challenges,”…

By
Mabruka Khan

COVID shots, newer vaccines in limbo after US court halts Kennedy’s advisory panel

The future of COVID-19 vaccinations in the United States has entered a period of uncertainty…

By
Shabih Abbas

DRAP Takes Strict Notice of Illegal Online Sale and Advertisement of Medicines

The Drug Regulatory Authority of Pakistan DRAP has taken strict notice of the online sale…

By
Neha Ashraf

PMDC Issues new Guidelines for House Job Admissions

PMDC has become active against individuals doing house jobs without a license. ‎PMDC has issued…

By
Neha Ashraf

For Whom can Taking Vitamin D be Dangerous? Find Out!

Vitamin D is extremely important for human health, especially for bone strength, the immune system…

By
Neha Ashraf

Gut Bacteria Linked to Recurrence of a Dangerous Disease Revealed!

‎A new study has found that bacteria present in the human gut can help determine…

By
Neha Ashraf

RFK Jr. Refused to Commit to Backing New CDC Director on Vaccines

Health Secretary Robert F. Kennedy Jr. has declined to clearly commit to supporting the newly…

By
Tasneem Juzar