Eli Lilly has expressed its opposition to a recent decision by the Centers for Medicare and Medicaid Services (CMS) that excludes anti-obesity medications from coverage under Part D, starting in 2026. In an open letter, Lilly stated that this move could limit patients’ access to weight-loss treatments, making it more difficult for them to receive appropriate care.
The CMS’s final ruling left out obesity drugs like Zepbound and Wegovy, which are currently available under “payer-driven” options in only a few states. This decision has sparked concerns among healthcare providers, who argue that the lack of coverage limits their ability to choose effective treatments for patients with obesity-related conditions, such as sleep apnea.
Lilly argues that Medicare Part D’s refusal to cover obesity medications is problematic because it forces drugmakers to seek regulatory approvals to expand the indications for their products. This process can be time-consuming and expensive, making it difficult for companies to pursue additional approvals.
In November 2024, the Biden administration proposed a rule that would allow Medicare Part D to cover anti-obesity treatments without requiring these actions. However, the CMS’s recent decision has cast doubt on this proposal.
The cost of covering obesity medications is a significant concern, with estimates suggesting that it could add $35 billion to federal spending from 2026 to 2034. While this may seem like a substantial amount, experts argue that the benefits of improved patient health would be limited.
Lilly’s open letter highlights the importance of ensuring that patients have access to effective treatments for obesity and related conditions. The company calls on CMS to reconsider its decision and work towards a more inclusive coverage policy.
Source: https://www.biospace.com/policy/we-dont-believe-this-is-right-lilly-bristles-as-cms-leaves-obesity-drugs-out-of-medicare