Medicare clarifies GLP-1 coverage for weight loss, shifting payment expectations

Medicare beneficiaries seeking coverage for GLP-1 drugs like semaglutide solely for weight loss received confirmation that these claims will continue to be denied under current Part D policy. This clarification follows recent coverage expansion for patients with type 2 diabetes and cardiovascular disease. Practices administering GLP-1s must ensure proper diagnostic coding aligns with covered indications (e.g., E11.9 for diabetes) and verify prior authorization requirements. For cash-pay weight loss services, update patient financial responsibility forms and provide clear cost estimates to avoid unexpected balances.