Hernandez Inmaculada, Wright Davene R, Guo Jingchuan, Shrank William H
Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
J Gen Intern Med. 2024 Feb;39(2):306-308. doi: 10.1007/s11606-023-08416-9. Epub 2023 Sep 15.
When the Medicare Part D benefit was constructed, drugs for weight loss were explicitly excluded from coverage, as the limited effectiveness and unfavorable safety profile of medications available at the time failed to justify coverage of drugs perceived to be used for cosmetic purposes. In recent years, drugs activating the glucagon-like peptide-1 receptor (GLP-1R) pathway have proved to achieve significant reductions in body weight with a favorable safety profile. The effectiveness of GLP-1R agonists in reducing weight and improving the metabolic profile warrants the reconsideration of the historical exclusion of weight loss drugs from Part D coverage. In this perspective, we outline policy options to enable Part D coverage of GLP-1R agonists. These include legislative change through the passage of the Treat and Reduce Obesity Act and evaluation of coverage policies under the waiver authority of the Center for Medicare and Medicaid Innovation.
在构建医疗保险D部分福利时，减肥药物被明确排除在承保范围之外，因为当时可用药物的有限疗效和不利的安全性未能证明为被视为用于美容目的的药物提供承保是合理的。近年来，激活胰高血糖素样肽-1受体（GLP-1R）途径的药物已被证明能显著减轻体重，且安全性良好。GLP-1R激动剂在减轻体重和改善代谢状况方面的有效性值得重新考虑历史上D部分对减肥药物的排除。从这个角度出发，我们概述了使D部分能够承保GLP-1R激动剂的政策选择。这些选择包括通过《治疗和减少肥胖法案》进行立法变革，以及根据医疗保险和医疗补助创新中心的豁免权对承保政策进行评估。
