What will happen if the ban is lifted
D.PoriesW.FahrbachK.et al (2004)
Reimbursement and Medicare Guidelines Reimbursement for CPT 62321 varies based on payer type, location, and place of service
This transition was driven by landmark trials, including ELIXIA (Evaluation of Cardiovascular Outcomes in Patients With Type 2 Diabetes After Acute Coronary Syndrome During Treatment With AVE0010 [Lixisenatide]), 23 LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results), 24 EXSCEL (Exenatide Study of Cardiovascular Event Lowering Trial), 30 HARMONY OUTCOMES (Effect of Albiglutide, When Added to Standard Blood Glucose Lowering Therapies, on Major Cardiovascular Events in Subjects With Type 2 Diabetes Mellitus), 38 and REWIND (Researching Cardiovascular Events With a Weekly Incretin in Diabetes), 37 which demonstrated significant reductions in MACE among patients with DM at high CV risk
This combination of increased usage and expanded state coverage has increased Medicaid spending on GLP-1s for obesity to more than $500 million in October 2024 alone, with total expenditures reaching $3.5 billion over the past 12 months