As GLP-1 medications have become more clinically prominent, there has been growing pressure on both Medicare and Tricare to revisit these exclusions, but as of the current policy landscape, Wegovy for weight loss without a qualifying diagnosis remains generally not covered under standard Tricare plans
Microdosing could also be rising in popularity as a way for these medicines to be more cost-effective during shortages. She says taking a low dose may also be appropriate for people who: want to avoid or minimize side effects of a particular medication, or have a history of being sensitive to medication side effects
Ultimately, finding the right balance requires collaboration with pharmacy benefit managers (PBMs) and healthcare consultants to create coverage based on workforce needs and risk factors
Ideally, states would like DSNP-based integrated care programs to be treated as a new delivery system, distinct from MA, with its own policies and procedures specially tailored to the needs of dual eligible individuals
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