Healthcare
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Health Care
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Temporary Medicare GLP-1 coverage begins tomorrow |
The Trump administration’s temporary program to cover GLP-1 medications for obesity starts tomorrow and runs through 2027, but we still don’t know for sure how much it will cost taxpayers.
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Medicare is prohibited by law from covering weight-loss drugs but the Centers for Medicare and Medicaid Services is allowed to test new payment models under short-term pilot programs. Eli Lilly and Novo Nordisk agreed to a monthly $245 price for their respective GLP-1 drugs, and in exchange will have access to a new pool of eligible Medicare beneficiaries.
Those beneficiaries will only pay $50 a month, but it won’t count towards their Part D deductible. Notably however, the program will only cover GLP-1 drugs for obesity, not for diabetes or any other indication.
Chris Klomp, director of Medicare at CMS, recently stated the agency anticipates the program will start with “single-digit millions” of beneficiaries.
According to a new estimate from KFF, an estimated 3.8 million beneficiaries could be eligible for Bridge as of 2023 data, based on meeting all the eligibility criteria.
Those with a body mass index, or BMI, of 35 or more qualify. Those with a BMI between 30 and 35 must also have one of the following: uncontrolled high blood pressure, prediabetes, a previous heart attack or stroke, blocked arteries in arms or legs with symptoms, chronic kidney disease at Stage 3a or higher or diastolic heart failure.
Patients also must go through a prior authorization process to be approved.
Once the program ends in 2027, it’s not clear what will happen.
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Welcome to The Hill’s Healthcare newsletter, we’re Nathaniel Weixel and Joseph Choi — every week we follow the latest moves on how Washington impacts your health.
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How policy will be impacting the healthcare sector this week and beyond:
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The Trump administration has terminated millions of dollars in teen pregnancy prevention grants that the Department of Health and Human Services said were no longer aligned with the agency’s priorities. HHS cut 53 grants worth about $67 million two years before they were set to expire. The cuts hit university, community, and public health grantees across more than two dozen states. According to a list seen by The …
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The Food and Drug Administration (FDA) will allow Zyn nicotine pouches to be marketed as less harmful to human health than cigarettes, the agency said Tuesday. The agency allowed the company to market 10 flavors of Zyn products, which have been authorized for sale in the U.S. since January 2025. These are the first nicotine pouches that are allowed to be marketed with a modified risk claim. It’s a significant win for tobacco …
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NEW YORK (WPIX) – A nationwide recall has been issued for a medication used to reduce the risk of hospitalization in patients with heart failure. Nearly 1 million bottles of Corlanor, known generically as ivabradine, are being recalled because they may contain a foreign substance, according to a Food and Drug Administration (FDA) recall alert. Corlanor is prescribed for adults with chronic heart failure to lower the risk of …
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Branch out with a different read:
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FDA expands cheese recall over possible listeria contamination
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(NewsNation) — More recalls have been announced tied to a deadly listeria outbreak that has been traced back to a Maryland-based cheese producer. La Ceiba Foods Latin Market Inc. is recalling products marketed under the La Colonia and Selectos Latinos brands. It includes Requesón Salvadoreño (Salvadoran Cottage Cheese) and Requesón Mexicano (Mexican Cottage Cheese). The products were distributed to markets and restaurants in …
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Local and state headlines on healthcare:
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- Hawaiʻi is losing therapists before they even start. A new law could help (Honolulu Civil Beat)
- Pennsylvania measles outbreak tops 70 cases as health leaders pledge to get spread ‘under control’ (WHYY)
- Here are the July 1 changes to Georgia medical cannabis law (11Alive.com)
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Health news we’ve flagged from other outlets:
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- May as well get COVID and flu shots on the same day, study says (MedPage Today)
- Even with MAHA, Trump administration has gone soft on alcohol (Stat)
- Here’s why your health insurer is sounding more like RFK Jr. (Politico)
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Opinions related to health submitted to The Hill:
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You’re all caught up. See you tomorrow!
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