Eli Lilly says some Medicare plans may exceed $50 cap for weight-loss drugs

March 9 (Reuters) – Eli Lilly said on Monday a small number of basic Medicare drug plans may not follow the $50 per month cap on out-of-pocket costs for its weight-loss drugs, after the Medicare agency said it has completed negotiations with Lilly and Novo Nordisk for a new weight-loss drug coverage model.

* The U.S. Centers for Medicare and Medicaid Services onMonday said state Medicaid agencies and Medicare Part D plansponsors can now apply to participate in the program that coversGLP-1 drugs for weight loss and diabetes. * Under the model, the agency will set standardized coverageterms by directly negotiating guaranteed net prices, potentiallycapping out-of-pocket costs and bundling evidence-basedlifestyle support. * CMS said last year eligible Medicare beneficiaries willpay $50 for a month’s supply of GLP-1 drugs, including Lilly’sinjectable Mounjaro and Zepbound. * Lilly said on Monday that while the majority of Medicareplan options will honor the $50 out-of-pocket cap, cost-sharingwill vary for beneficiaries in a small number of basic MedicarePart D plans. * Beginning January 1, 2027, Lilly’s Zepbound, Mounjaro andorforglipron, if approved, will be available through MedicarePart D participating plans under this program. * Lilly said it will actively educate patients and theirphysicians about plan options as well as smoothing programs thatcan help patients access GLP-1 medications at the lowestpossible out-of-pocket costs. * Medicare Part D is the prescription drug benefit thathelps Medicare enrollees pay for outpatient medications throughapproved private plans.

(Reporting by Sneha S K; Editing by Alan Barona)