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111. Diving Deep On GLP-1 Coverage and Drug Price Reform Models

111. Diving Deep On GLP-1 Coverage and Drug Price Reform Models

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 We dive deep on GLP-1 coverage and drug price reform models. President Trump certainly deserves credit for the major accomplishments. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc dives deep on GLP-1 coverage and drug price reform models. President Trump certainly deserves credit for the major accomplishments. Key Takeaways: We dive deep on GLP-1 coverage and drug price reform models. President Trump certainly deserves credit for the major accomplishments. The president has been proposing seismic reforms for drug pricing, including direct talks with brand drug makers. Over a dozen drug makers offered price concessions, including makers of GLP-1 weight-loss drugs. A new Medicare and Medicaid model would reduce costs for GLP-1 weight-loss drugs and expand coverage to help those with obesity alone and no other underlying disease states. Cost-sharing would be no more than $50 per month in Medicare. The models start in 2026 for Medicaid and 2027 for Medicare. As promised, Trump also proposed most-favored nation (MFN) drug pricing in Medicaid and Medicare. The Medicaid model is called GENEROUS and would set MFN pricing on all Medicaid drugs for participating drug makers. The MFN price in Medicaid would be the second-lowest price in a set of eight developed world countries. The Medicare models are called GLOBE for Part B drugs and GUARD for Part D drugs. A subset of B and D drugs would be covered, and the models are mandatory for drug makers. About 25% of beneficiaries with B or D drug costs would be in each model. The MFN price in Medicare B and D is based on 19 developed-world countries and would be either the lowest international price from commercially available data sources or the average international price as reported by drug makers. A big debate has emerged on MFN pricing and the impact on innovation. Some advocate for prospective MFN on new drugs only, while others want retrospective MFN, applying it to existing drugs as well. Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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