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Alliance Comments on Medicare Proposed Rule

Published January 27, 2025

Two oblong white pills sitting on top of some American currency.

In a letter to the Centers for Medicare & Medicaid Services today, the Alliance for Aging Research commented on the proposed rule to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for 2026. Among other points, the Alliance:

  • Supports the provision allowing coverage of Anti-Obesity Medications (AOMs): Obesity is a medical condition that increases the risk of severe health issues like cardiovascular disease and diabetes. The letter notes that CMS does have the regulatory authority to provide coverage, emphasizing that exclusions for weight loss drugs were historically tied to cosmetic use, not medical treatment. Advances in understanding obesity as a disease with genetic and physiological factors strengthen the case for including AOMs under Medicare coverage.
  • Urges CMS to finalize the auto-renewal provision and continue to refine the Medicare Prescription Payment Plan under the lens of several guidelines, including:
    • Expanding educational outreach to improve beneficiary awareness of the program.
    • Supporting CMS’ auto-renewal provision to reduce administrative barriers.
    • Urging CMS to incorporate point-of-sale enrollment options at the pharmacy counter.
    • Regular reporting on participation in and the impact of the program.
  • While not referenced specifically in the proposed rule, the Alliance encourages CMS to edit the final rule to include additional guardrails against the abuse of utilization management practices including prior authorization, step therapy, and cost sharing. The Alliance highlights potential negative impacts of increased UM practices resulting from changes under the IRA. These practices may lead to delays, higher costs, and poorer outcomes for patients. The Alliance urges CMS to:
    • Enhance transparency about UM practices.
    • Educate beneficiaries on how UM affects their plans.
    • Develop benchmarks to monitor access impacts from UM changes.

Read the full letter.

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