Medicare's State Health Insurance Assistance programs are still up and running!

(For those who might not know about the role of SHIPs in helping people with Medicare navigate their coverage options, our new @KFF brief explains) www.kff.org/medicare/the...

Requiring Medicare to cover drugs to treat obesity would have increased Medicare spending by $25 billion over 10 years, but would also have helped millions of people with Medicare who might benefit from these drugs but can’t afford them due to their high price tags. www.kff.org/policy-watch...

Spending on anti-obesity drugs has skyrocketed in recent years, even though they are now only covered under Medicare for uses other than obesity. One of these drugs, Ozempic (semaglutide), was recently selected for Medicare drug price negotiation, with total gross spending of $14 billion in 2024.

How workforce reductions at the Social Security Administration will affect people is unknown, but could make it harder for people to get connected to benefits they might qualify for through paperwork delays or other hurdles, which would in turn affect coverage through Medicare and/or Medicaid.

Social Security is also a pathway to health coverage for people with disabilities, who can qualify for Medicare after receiving disability benefits for two years, or Medicaid for people receiving Supplemental Security Income, as our @kff.org brief explains. www.kff.org/medicare/iss...

The outgoing Biden administration has proposed this change, but we don’t know yet whether the incoming Trump administration will decide to finalize this proposal.

The outcome matters not just for the people on Medicare who are currently using these drugs for diabetes and cardiovascular disease risk reduction, but those who would take this drug in the future if Medicare coverage expands to cover anti-obesity drugs, which is currently prohibited.

It's important to note that this is a proposed rule that will be finalized under the incoming Trump administration. Will the new administration finalize the change as proposed, try to modify it, or pull back altogether on this popular idea of allowing Medicare to cover these drugs? Time will tell.

This would be a big deal for millions of people with obesity on Medicare who currently have to pay the full price of these drugs out of pocket, if they can even afford to - unless they also have another condition where Medicare is already authorized to cover these drugs, like for type 2 diabetes.

It's also worth keeping an eye on the several lawsuits that have been filed against the negotiation program by drug companies and the pharma industry, and how vigorously HHS under President-elect Trump will continue to defend the program in court.

It is unclear what direction the incoming Trump administration might choose to take with respect to the negotiation program, but it certainly seems possible that the approach to implementation in 2025 and beyond may differ from that which was laid out in CMS’s most recent guidance.