CMS
Recently the FDA expanded the potential uses of Wegovy to include treatment for cardiovascular risks in overweight people. This change opens the door for Medicare to cover the expansive drug. Given the large number of Medicare beneficiaries with heart disease, the impact on the Medicare program could be large. CMS is currently reviewing how it will cover Wegovy.
Change Healthcare
HHS announced that it was opening an investigation into the Change Healthcare cyber attack to determine if there were possible HIPAA violations. HHS has increased pressure on the company in recent to fix the issue and protect providers/patients.
Congress
Politico reported that several members of Congress (namely Larry Bucschon) were working on a comprehensive bill to address reimbursement issues at CMS (reducing cuts, increasing transparency, etc.)
Courts
The 8th circuit ruled that Arkansas can block manufactures from limiting the availability of discounted drugs from the 340B program. The ruling is expected to encourage other states from implementing similar laws.
Biden Budget
President Biden released his proposed fiscal year 2025 budget. While the budget is not something that will be implemented, it does provide a window into policy priorities. Within the budget proposal there is funding for renewal of enhanced premium subsidies for individual market, a coverage option for individuals in the Medicaid coverage gap, expansion of the number of drugs Medicare can negotiate with and raising taxes on high-income individuals to help stabilize the Medicare trust fund.
