The program started before specialty drugs became such a large expense for Medicare and its beneficiaries. Congress is considering legislation that would cap beneficiary out-of-pocket costs and require price discounts from manufacturers.
Novo Nordisk’s Saxenda (liraglutide) and Wegovy (semaglutide) are leading the way for a new crop of drugs that reduce appetite. But their cost-effectiveness is in question, and many payers are saying no to coverage — for now.
As Congress considers legislation that would cap out-of-pocket costs for insulin, Walmart and Civica Rx are taking steps that could make less expensive versions of the diabetes medication more available.