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Medicare can start covering certain weight loss drugs for the first time — as long as they are approved for an added health benefit, the Centers for Medicare and Medicaid Services said Thursday. Medicare prescription drug plans administered by private insurers, known as Part D, currently cannot cover those drugs for weight loss alone. A provision of a 2003 law established that Medicare Part D plans can't cover drugs used for weight loss, but the program does cover obesity screening, behavioral counseling and bariatric surgery. A CMS spokesperson told CNBC last week that Medicaid programs would be required to cover Wegovy specifically for its new cardiovascular use. Around 1 in 5 state Medicaid programs currently cover GLP-1 drugs for weight loss.
Persons: Ozempic, Eli Lilly Organizations: Novo Nordisk, Medicare, Centers, Services, Drug, Food and Drug Administration, CVS, Aetna, International Foundation of Employee, CNBC, FDA Locations: London, Britain, U.S
The blockbuster drug — one of a handful of weight loss treatments to skyrocket in popularity over the last year — is now approved in the U.S. for heart health, too. The spokesperson added that state Medicaid programs would be required to cover Wegovy for its new cardiovascular use. But Gremminger said the standard of care for the long-term use of weight loss drugs is "in flux." State employees will no longer have insurance coverage for GLP-1s when used for weight loss at the beginning of next month. Both drugmakers have launched programs to help patients, with or without commercial insurance coverage, afford their weight loss treatments.
Persons: Klesty, John Crable, Wegovy, Jaime Almandoz, Joe Buglewicz, Shawn Gremminger, Hartley, Gremminger, Dale Folwell, We've, Folwell, Phelan M, Eli Lilly, Ceci Connolly, Julie Stich Organizations: Reuters, Novo Nordisk, CNBC, Medicare, Services, FDA, CVS, Aetna, International Foundation of Employee, Drug Administration, University of Texas Southwestern Medical Center, Washington Post, Getty, National Alliance of Healthcare, Taft, Nordisk, Nordisk's Ozempic, GOP, Carolina, Republican Governors Association, AP, Alliance of Community Health, U.S . Health, IFEBP, BMI Locations: U.S, Novo, Dallas, North Carolina, Orlando , Florida
That’s because more employers are providing fertility benefits to their workers, opening up the costly procedure to many more Americans. However, most employers place limits on IVF coverage. The share of employers providing fertility benefits has likely increased since 2022 for several reasons, said Julie Stich, the foundation’s vice president of educational content. Some employers are providing fertility coverage to prevent these situations. Alabama decisionDespite the Alabama ruling, employers are not likely to drop their fertility benefits since they are important for talent acquisition and retention, said Kate Ryder, founder and CEO of Maven Clinic, which works with employers and health plans to provide fertility and family building programs, among other services.
Persons: CNN —, it’s, Mercer, Julie Stich, “ There’s, , Stich, Kate Ryder, there’s, ” Ryder, Harvey Cotton Organizations: CNN, CNN — Alabama’s, International Foundation of Employee, of Columbia, Maven Clinic, Ropes & Gray Locations: Alabama
Many U.S. companies are grappling with health insurance coverage issues for workers when it comes to GLP-1 drugs for weight loss. Still, many benefits experts say it's a matter of when, not if, more employers will cover GLP-1 drugs. Certainly, prescription volumes of GLP-1 weight loss drugs are soaring. Even though GLP-1 drugs are high-priced, they currently represent only 6.9% of annual claims, according to data from the International Foundation of Employee Benefit Plans. It's going to be harder and harder not to cover these drugs because the benefits seem to be so great."
Persons: Eli Lilly, there's, Julie Stich, Eli Lilly's, Greg Stancil, you've, Stancil, somebody's, James Wantuck, " Stich, Brian O'Connell, O'Connell, Wantuck, Krutika Amin, Amin Organizations: U.S, Nordisk, International Foundation of Employee, Novo Nordisk, Tufts Medical, Medicare, Healthy Aging, Scott Benefit Services, Employers, Accolade, BMI, International Foundation of, Medicaid — Locations: U.S, KFF, North Carolina, GLP, Novo
Fg Trade | E+ | Getty ImagesYour employer may have its own policyAround nine out of 10 U.S. companies offer bereavement leave, according to the International Foundation of Employee Benefit Plans. Adam Lister | Moment | Getty ImagesThe leave companies provide tend to vary based on who in your life has died. The average for an immediate family member was around five days, compared to roughly one day for a close friend, IFEBP found. Some states offer bereavement leaveIn the absence of a federal bereavement leave policy, some states have established their own program or are trying to do so. A California law guarantees most employees five days of bereavement leave following the death of a family member.
Persons: Julie Stich, Stich, Johnson, Adam Lister, IFEBP, they've, " Stich Organizations: International Foundation of Employee Locations: U.S, California, Illinois
There is likely a long way to go before the U.S. sees increased insurance coverage for obesity drugs. While the trial results demonstrate that obesity drugs may have significant health benefits beyond shedding unwanted pounds, organizations representing U.S. insurers emphasized that the data is still preliminary. "Health insurance providers will continue to analyze new evidence as it becomes available," he added. Ceci Connolly, CEO of the Alliance of Community Health Plans, acknowledged the promise of the data but said "outrageous prices should give everyone pause." The organization represents regional, community-based health plans that cover more than 18 million Americans across the U.S.
Persons: Jim Vondruska, Wegovy, Eli Lilly, David Allen, Ceci Connolly, Jared Holz, It's, Debra Tyler's, Joe Buglewicz, Eduardo Grunvald, George Frey, UCSD's Gunvald, Eli, Ethan Lazarus, Lazarus Organizations: Reuters Novo Nordisk, Novo Nordisk, America's Health, Alliance of Community Health, U.S, Drugs, Pfizer, Medicare, CVS, Aetna, CNBC, Washington Post, Getty, UCSD Health's Center, International Foundation of Employee, University of Texas System, UTS, Novo, Reuters, Obesity Medicine Association, New England, of Medicine Locations: Chicago , Illinois, U.S, Mizuho, Killingworth, Conn, Texas
Atlanta single father Jon had his son Theo after a decade of saving and strategizing with employer benefits and advocacy group help. "I worked for a decade to make this family happen," the Atlanta-based single father said. His company didn't initially offer fertility benefits for men. "The tech sector and the financial services sector have been very proactive in offering fertility benefits," said Anthony Brown, an attorney and manager of client services at Circle Surrogacy. The tech sector and the financial services sector have been very proactive in offering fertility benefits.
Persons: Jon, Theo, Jon G, Rebecca Willman, didn't, Anthony Brown, Brown Organizations: International Foundation of Employee Locations: Atlanta, U.S
watch nowWhy gay male couples face higher costsAlon Rivel, left, with his family. Gay male couples typically face a more expensive journey, as surrogacy or adoption are their primary choices. Employer fertility benefits offer limited helpMore employers are starting to offer fertility benefits, often through a specialized fertility benefits manager like Kindbody, Carrot, Progyny or Maven. But while more companies are offering fertility benefits, many of these packages are limited when it comes to covering what's needed to build families with non-traditional methods. At Rivel's insistence, he asked his human resources department to look into including surrogacy benefits.
Persons: Alon Rivel, Alon Rivel Alon Rivel, Rivel, Betsy Campbell, Maven, Will Porteous, Doug, Walter ., Porteous, Progyny's, Pete Anevski, Tammy Sun, Taryn Branca, they'll, Anevski, it's, Resolve's Campbell, Hanna, Stephen Hanna, Bret Shuford, Maverick Organizations: International Foundation of Employee, Equality, Mercer, Maven, Beam Therapeutics, Child Welfare Locations: Arlington , Massachusetts, U.S, Wynnewood , Pennsylvania, West, Massachusetts
Companies that pay for workers' health insurance are grappling with how to cover the pricey drugs. Medicare, the federal program that provides health coverage for people 65 and older, doesn't cover weight-loss drugs. ArcBest already has a program to help workers lose weight through behavior changes and nutrition. Krutsch said he wants to build on that, covering the weight-loss drugs Wegovy and Saxenda for employees who aren't able to lose weight without medication. The new weight-loss drugs were in short supply in 2022, and that gave employers time to figure out how to handle them, he said.
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