WASHINGTON — The Trump administration had planned for insurers to provide cheap weight loss drugs to seniors through a Medicare pilot program. Insurers said no, so the government will instead cover the drugs outside of the Medicare Part D drug benefit.
Last year, the Trump administration struck a deal with Eli Lilly and Novo Nordisk to lower the prices of their popular obesity drugs in exchange for expanding access to those drugs in Medicare and Medicaid. Medicare is prohibited from covering weight loss drugs, but the administration proposed waiving that restriction to test whether covering the medications would save tmoney or improve health outcomes at no additional cost.
The hitch was that insurers had to agree to participate in the pilot, called BALANCE, even though they would likely have faced a financial strain from doing so. The drugmakers agreed to sell the treatments for $245 a month in Medicare and Medicaid, but Medicare promised that beneficiaries would only pay $50 each month.
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