March 9 (Reuters) – Eli Lilly said on Monday a small number of basic Medicare drug plans may not follow the $50 per month cap on out-of-pocket costs for its weight-loss drugs, under the Medicare agency’s weight-loss drug coverage model.
* The U.S. Centers for Medicare and Medicaid Services lastyear announced a voluntary program to cover GLP-1 drugs forweight loss and diabetes under Medicaid and Medicare Part Dplans. * Under the model, the agency will set standardized coverageterms by directly negotiating guaranteed net prices, potentiallycapping out-of-pocket costs and bundling evidence-basedlifestyle support. * CMS said last year eligible Medicare beneficiaries willpay $50 for a month’s supply of GLP-1 drugs, including Lilly’sinjectable Mounjaro and Zepbound. * Lilly said on Monday while the majority of Medicare planoptions will honor the $50 out-of-pocket cap, cost-sharing willvary for beneficiaries in a small number of basic Medicare PartD plans. * Beginning January 1, 2027, Lilly’s Zepbound, Mounjaro andorforglipron, if approved, will be available through MedicarePart D participating plans under this program. * Lilly said it will actively educate patients and theirphysicians about plan options as well as smoothing programs thatcan help patients access GLP-1 medications at the lowestpossible out-of-pocket costs. * Medicare Part D is the prescription drug benefit thathelps Medicare enrollees pay for outpatient medications throughapproved private plans.
(Reporting by Sneha S K)
