Medicare's pilot GLP-1 discount program has a catch; some sick patients don't qualify

CMS's pilot program to lower GLP-1 drug costs for Medicare beneficiaries includes strict clinical criteria that exclude some patients with obesity-related complications. The program, designed as a test of value-based pricing, requires a specific BMI threshold and the presence of at least one cardiovascular condition, leaving out patients with conditions like osteoarthritis or sleep apnea. This creates a coverage cliff for practices managing complex patients and illustrates the operational friction of CMS's incremental approach to covering weight-loss drugs.