On Thursday, the House Ways & Means Committee moved forward with four significant pieces of legislation aimed at enhancing Medicare coverage and modifying certain regulatory frameworks. These bills, passed with robust bipartisan support, address the inclusion of obesity drugs and cancer screening tests under Medicare and implement changes concerning Medicare’s discretion in the coverage of drugs and devices that have received FDA approval.
One of the key bills passed pertains to the coverage of obesity drugs for adults aged 65 and older, a demographic traditionally excluded under current Medicare rules from receiving weight loss medications. This legislation marks a shift from a blanket prohibition to a more selective approach, targeting those who have already been prescribed obesity drugs prior being eligible for Medicare coverage. The intention, as stated by Committee Chair Jason Smith (R-Mo.), is to prevent seniors from either losing access to these drugs or facing steep out-of-pocket costs upon turning 65—a change that could not only affect individual health outcomes but also potentially lead to increased long-term medical costs for future taxpayers.
Despite the substantial support, concerns remain, particularly from top Democrats such as Rep. Richard Neal (D-Mass.) and Rep. Lloyd Doggett (D-Texas). Rep. Neal, in particular, voiced apprehensions about the bill’s selective nature, potentially creating disparity by only extending coverage to those who previously had private insurance plans that included such drugs. This approach, according to Neal, could create a divided system within Medicare, favoring the insured over the less financially fortunate.
Another widely supported bill seeks to expand Medicare coverage to include more comprehensive cancer screening processes. Historically, Medicare has only covered FDA-approved tests for diagnosing diseases but has not covered screenings like the Grail Galleri test, which screens for multiple types of cancer. The bill, which was passed unanimously, proposes changes that would allow Medicare to start covering these critical cancer screenings beginning in 2028 for certain age groups, with gradual expansion. The implementation includes a strategic financial plan to delay significant portions of the incurred costs beyond the Congressional Budget Office’s 10-year forecasting window. This tactic addresses the potential financial impact, which could extend into the tens of billions.
The committee also deliberated on a bill aimed at smoothing the pathway for Medicare coverage of FDA-approved innovative medical devices, particularly those under the breakthrough devices program. There has long been frustration among device manufacturers over the lag between FDA approval and Medicare coverage, which usually sets the precedent for private insurers. The bipartisan bill proposes a revised framework, granting CMS explicit authority to provide temporary coverage for these breakthrough devices based on clinical trial data pertinent to Medicare beneficiaries. However, this revised proposal still raises concerns among some Democrats about potentially undermining CMS’s ability to protect beneficiaries from unnecessary or unsafe devices.
Lastly, the committee addressed legislative changes requiring Medicare to reevaluate coverage decisions every 10 years, a move prompted by ongoing discussions around a new class of Alzheimer’s drugs. This change could reflect a more dynamic approach to adapting Medicare coverage policies in response to evolving medical standards and technologies.
These legislative efforts, while addressing different aspects of health care, collectively signal a notable shift towards broadening and refining Medicare’s scope of coverage. This includes a focus on preventive health measures and more rapid integration of new medical technologies, while also grappling with the financial implications and ensuring equitable access across the Medicare spectrum. As these bills move through the legislative process, they will likely spur further discussions on both the potential impacts and the structural changes necessary within the U.S. healthcare system.
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