Céline Gounder, KFF Health News’ editor-at-large for public health, discussed fatal measles cases on CBS News 24/7’s Mornings on Aug. 26. Gounder fact-checked Centers for Medicare & Medicaid Services Administrator Mehmet Oz’s comments about vaccines and drug prices on CBS News 24/7’s The Daily Report on Aug. 24. She also discussed food recalls this summer on CBS News 24/7’s The Takeout With Major Garrett on Aug. 24.
KFF Health News contributor Mark Kreidler discussed the use of artificial intelligence for Medicaid reenrollment on KVPR’s Central Valley Daily on Aug. 24.
KFF Health News Georgia correspondent Briah Lumpkins discussed the importance of healthcare policy in upcoming elections on WUGA’s The Georgia Health Report on Aug. 21.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
In the summer of 2024, Emilie and Justin Solomon found themselves on a top-secret mission in Greece.
Their family and friends thought the adventure-loving couple was on another jet-setting vacation, but they were keeping something else under wraps: They had turned off their phone locations to hide visits to a Greek clinic where they were trying to get pregnant.
The Solomons are among the growing numbers of Americans looking abroad, particularly to Greece and Spain, to escape the high cost of fertility treatments in the U.S., where such procedures are often not covered by insurance. The treatments include in vitro fertilization, which involves ovulation stimulation, retrieving the eggs, fertilizing them in a lab, and transferring the embryos into the uterus. Other less intensive medical therapies also address infertility.
Emilie and Justin Solomon visited Greece for IVF treatment in 2024 after they were quoted $40,000 for one round of treatment in Florida. (Emilie Solomon)
President Donald Trump has made fertility, and IVF in particular, a focus of his administration’s agenda after he promised total coverage for women during his 2024 campaign. His administration proposed a rule in May intended to make it easier for employers to offer fertility coverage, although it has yet to be finalized. So far, the most concrete result has been lower costs for some IVF medications through TrumpRx, a site where cash-paying patients can find some discounted medicines through participating pharmacies. The White House projected that patients could save up to $2,200 per IVF cycle.
While significant, those savings are up against a 90% rise in IVF medication costs since 2014, according to GoodRx, a prescription discount service. A study of insured Americans released in July by Axene Health Partners and the Women’s Reproductive Health Foundation found that the overall cost for a cycle of IVF was over $29,000 — or 35% of the median annual household income in the U.S. Genetic testing, embryo storage, pregnancy care, and delivery costs can push the total over $54,000 per IVF-conceived birth, according to the study. An average patient needs two to three cycles to successfully have a child, so the costs for many patients would be even higher.
Infertility affects nearly 7 million people in the U.S., but only an estimated 24% of treatment needs are met, because of those high costs and limited insurance coverage, according to the American Society for Reproductive Medicine. The condition is believed to be rising partly because of people having children later, as well as environmental factors such as pollution.
Still, more than 100,000 babies were born via IVF in the U.S. in 2024 — a record, according to the Society for Assisted Reproductive Technology. An increasing share of people hoping to be parents are seeking help in Europe: The number of Americans choosing European clinics grew by more than 37% last year, according to Jakub Dejewski, the chair of the European Fertility Society, a group that tracks data on fertility treatment in Europe.
The Solomons knew IVF was their only chance to have children together biologically, because Justin had testicular cancer in his late teens. What the college sweethearts had not expected was the cost — and they learned early in their IVF journey that their insurance would not cover their treatment. While some states have passed laws to require insurers to pay for some fertility care, the coverage varies widely.
When the couple first explored IVF in Florida, where they live, they were quoted $40,000 for one round of treatment. The price shocked them, and Emilie said the clinic’s offer of a spring discount for an embryo transfer felt “off-putting.”
“They just kind of prey upon your hopes and dreams to be parents,” Emilie said.
Treatment Plus Island-Hopping Tours
The price of IVF and uncertainty around proposed personhood legislation in Florida, which the Solomons feared could jeopardize their control over their embryos, sent them to the Pelargos IVF Medical Group in Athens. There, in the first of two trips, Emilie underwent ovulation stimulation and egg retrieval.
Including medication, fertilization, storage, and the ultimate embryo insertion, the total treatment cost about $12,000, not including travel, according to the Solomons, a fraction of what they might have spent in America. That affordability drew the couple abroad, but so did the allure of sightseeing and experiencing a new country.
On that first trip, they spent a weekend between doctor appointments exploring the Greek island of Milos. Between Emilie’s hormonal injections, they rented a boat to explore the island. Their video from the trip shows them climbing the island’s striking white volcanic cliffs, and Emilie floating in the turquoise water of the Aegean Sea. Despite the emotional and physical toll of the IVF process, the couple remembers being in a little bubble, away from everyone, exploring a beautiful place.
“It was one of the best summers that we’ve had,” Emilie said.
In Greece, the Solomons were able to get a round of the IVF treatment for about $12,000, not including their travel expenses. (Emilie Solomon)
When they traveled back to Greece for their embryo transfer in October 2025, they spent two days in Croatia.
IVF in Greece using a patient’s own eggs typically costs around $3,000 to $4,000, not including medication, so even with travel, it is often a fraction of what patients pay in the U.S.
“Americans choose Greece because they can access treatment that is more affordable, faster to begin, and well supported for international patients,” Dejewski said.
Jakub Dejewski, the chair of the European Fertility Society, which tracks data on fertility treatment in Europe, says the number of Americans choosing European IVF clinics grew by more than 37% in 2025 from the year before. (Dawid Linkowski)
Patients in Greece do face some legal restrictions: Embryo storage is time-limited, donor anonymity is standard, sex selection and embryo-transfer numbers are restricted, surrogacy access is limited for nonresidents, and patients must carefully consider documentation requirements if they plan to move embryos between Greece and the U.S.
Penny Ampatzi said she is clear about these legal differences when Americans consult with her clinic in Athens. Serum IVF offers to schedule airport pickup for patients, as well as island-hopping tours. Ampatzi, the co-founder and clinic director at Serum IVF, said the main draw for the dozen or so American patients her clinic sees each month is the personalized fertility treatment plans. Affordability is close behind. A cycle at her clinic costs just under $6,000, not including embryo freezing. Almost all of Serum’s patients are foreigners, according to Ampatzi.
“You consider that you have a good possibility of success, plus you don’t pay that high amount of money, and you also have combined the treatment with holidays — so it’s a ‘Why not?’” she said.
Not Without Risks
IVF costs in the U.S. have been driven up by a mix of inflation, a shortage of embryologists, a surge in demand after pandemic backlogs, and private equity ownership, Dejewski said.
William Kiltz, vice president of marketing and business development at U.S.-based CNY Fertility, said that the costs are becoming too far out of reach. “IVF is almost a treatment that only the top 1% can afford reasonably,” he said.
Kiltz said CNY’s model — offering IVF for around $8,000, not including embryo storage, at its 18 locations across the country — brings just enough profit to “keep the lights on” and open new locations while keeping its costs lower. “We’re trying to deliver this care at the absolute bare-minimum cost,” he said.
More than half of CNY’s patients travel from out of state in search of those lower-cost options, Kiltz said.
He said he hopes the IVF market will eventually settle out, as happens with many new technologies. But nearly five decades in, that normalization hasn’t come. Kiltz believes that’s because the market is so emotionally driven.
“People will do just about anything,” Kiltz said. “There’s certainly some risk in something like that, where the demand and the desire from a single individual is so strong that they could be taken advantage of.”
Tarita Pakrashi, the head fertility doctor at the CNY location in Norfolk, Virginia, pointed to the difficulties of trying to vet a clinic overseas when one doesn’t speak the language or understand the local IVF regulations. It also can be challenging to transport temperature-sensitive medication back home.
“It’s almost like a full-time job trying to play regulatory expert and inspector all at the same time, while you’re a patient,” Pakrashi said.
She said she also has had patients who sought treatment abroad return to her clinic struggling to transfer records or understand a diagnosis they received overseas. They often have to repeat tests.
And going abroad for IVF is still out of reach financially for many Americans.
The Solomons said seeking treatment overseas takes a certain type of adventurous spirit, too. But for them, all the logistics and travel were worth it. Their one cycle of IVF and two trips to Greece allowed them to welcome a healthy baby boy this summer.
After undergoing one round of IVF treatment in Greece, Emilie Solomon gave birth to a son this summer in Florida. (Susie Urff)KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Union Health Minister J P Nadda reviewed the progress of the projects on Thursday and directed officials to ensure time-bound implementation, regular monitoring and coordination between ministries, states and institutions.
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The KFF Health News Minute is available every Thursday via direct download or the RSS feed.
Aug. 27
Katheryn Houghton [CATH-er-in HOW-tun] reads the week’s news: A wristband with the words “I Gave Birth” could be a lifesaving tool for new moms, and many homeless people will have to prove they’re working to stay on Medicaid.
Arielle Zionts [arr-ee-ELL ZY-ence] reads the week’s news: Pediatricians try to persuade more parents to vaccinate their kids amid measles outbreaks. Plus, how hospital monopolies drive up costs for patients and insurers.
Rachel Spears reads the week’s news: Many people with disabilities fear that a new Justice Department legal opinion could roll back protections that have given them access to in-home care. Plus, some cities are using 911 to respond to mental health distress calls with mobile crisis teams instead of police.
Katheryn Houghton [CATH-er-in HOW-tun] reads the week’s news: Some older adults are seeking roommates to help them age in place. Plus, doctors say they shouldn’t be the ones determining if someone is too sick to comply with Medicaid’s new work rules.
Zach Dyer [DYE-er] reads this week’s news: Health insurance companies promised to make it easier to get doctor-ordered care, but patients are still waiting. Plus, a common surgery might not be the best way to solve knee pain.
Jackie Fortiér [FOR-tee-ay] reads this week’s news: Coverage disruptions can have fatal consequences when switching health plans. Plus, more states are shaming employers that use your tax dollars to cover health costs for their low-income workers.
Sam Whitehead reads the week’s news: Some health plans are pocketing their enrollees’ drug discounts, while many Affordable Care Act insurers want to raise rates by double digits next year.
Rachel Spears reads the week’s news: When babies receiving infant formula allegedly get sick or die, what happens next is largely up to the companies that make it. Plus, abortions continue to rise four years after the overturning of Roe v. Wade.
Jackie Fortiér [FOR-tee-ay] reads the week’s news: More Americans than ever are surviving cancer and face lingering mental health issues. Plus, tips to get your health insurance company to pay for a GLP-1 drug.
Zach Dyer [DYE-er] reads the week’s news: The U.S. is getting its first new sunscreen ingredient in decades. Plus, at-home cancer tests have their limits.
Katheryn Houghton [CATH-er-in HOW-tun] reads the week’s news: New rules that require millions of Americans to work to access Medicaid are stricter than many expected. Plus, the federal Family and Medical Leave Act protects many people’s jobs — but there’s a big catch.
Sam Whitehead reads the week’s news: More Americans are getting access to physician-assisted suicide as states legalize the practice. Plus, hundreds of people allege medical neglect in ICE detention centers.
Arielle Zionts [arr-ee-ELL ZY-ence] reads the week’s news: For some older adults, the risks of certain preventive screenings might outweigh the rewards. Plus, cost spikes for Obamacare plans have consumers seeking cheaper health coverage, which is often less comprehensive.
Jackie Fortiér [FOR-tee-ay] reads this week’s news: Suicide prevention experts argue that improving Americans’ financial well-being could save lives. Plus, the Trump administration proposes looser artificial intelligence safeguards to speed innovation in healthcare.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Earlier this month, global investment firm KKR signed a deal to buy Medicover's India business for €1.2 billion ($1.40 billion), pending regulatory approvals.
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At Chain of Lakes Elementary School in Winter Haven, Florida, Josette Smith’s 9-year-old son, Ethan, gets to do what he loves most: crafts, math, and science. That is, when he isn’t being pulled out of class.
Ethan has autism and attention-deficit/hyperactivity disorder. He was diagnosed with autism in kindergarten after displaying behavior that concerned his relatives: He paced, flapped his arms, and became consumed with highly specific interests, such as Martin Luther King Jr. and dachshunds.
In a meeting with school administrators and the district to develop his individualized education program, a legal agreement that outlines the support Ethan requires, the team agreed he required a trained paraprofessional to help him regulate his emotions and remain in class, according to complaints Smith filed against the school. However, the complaints alleged, administrators were unwilling to provide the dedicated aide. Instead of implementing the supports her son needed, his school repeatedly removed him from instruction, suspended him, and even called police on him when he was in third grade, Smith wrote.
Smith, a seventh grade science teacher, said she first filed complaints with the school district and the state with these allegations. But when problems persisted, she turned to the U.S. Department of Education’s Office for Civil Rights, the federal agency tasked with resolving complaints like hers. Smith’s federal complaint included the same account and alleged that the school discriminated against her son because of his disability and race, including deploying pressure tactics to push her Black son out of the public school. In May, the office said it would investigate several of her allegations.
For families who believe their child’s rights were violated based on race, disability, or gender in school, the federal agency often has been one of the main places to turn. But the White House cut its offices and weakened its ability to follow up with cases, as well as slashed funding to research on disparities that people of color face in getting diagnosed and attaining resources for disabilities.
About 1 in 31 U.S. kids by age 8 had been diagnosed with autism spectrum disorder as of 2022. Although previous research on disparities in childhood autism diagnoses has had mixed results, a recent study from the State University of New York at Albany’s Institute for Social and Health Equity found that race, gender, and socioeconomic gaps persist. Among fourth graders from 2003 to 2022, students of color, girls, low-income students, and multilingual learners were less likely than peers to be identified with autism in school, even as diagnoses rose among children from historically marginalized groups, the study found. A large forthcoming study by the same researchers found the biggest gaps among overlapping identities. Black and Hispanic girls were especially unlikely to be identified.
All this has happened as President Donald Trump’s second administration has put autism in the spotlight. In early August, Trump signed an executive order to whittle down routine immunizations for kids while falsely tying vaccines to autism. He has presented it as a personal priority and one of “the most alarming public health developments in history.” Health and Human Services Secretary Robert F. Kennedy Jr. in April 2025 called autism a “tragedy” that “destroys families,” and he’s lent credence to ungrounded claims of autism’s causes, including unfounded links to childhood vaccines and Tylenol during pregnancy.
“This administration is taking us backwards,” said Camille Proctor, founder and executive director of The Color of Autism Foundation.
HHS spokesperson Emily Hilliard said in an email that Kennedy’s statements last spring “emphasized the need for increased research into environmental factors contributing to the rise in autism diagnoses, not to stigmatize individuals with autism or their families.” She added that the agency changes are “about making federal support systems work better for children and families.” White House spokesperson Kush Desai did not respond to a request for comment. Neither did the press office for the Department of Education.
Josette Smith filed a complaint with the federal Department of Education’s Office for Civil Rights on behalf of her 9-year-old son, Ethan, alleging that his school in Winter Haven, Florida, discriminated against him because of his disability and race. The office said it would investigate several of her allegations and dismissed others that the state had already reviewed. (Octavio Jones for KFF Health News)
Ethan was repeatedly removed from class, suspended, and charged with battery as a third grader at a public school in Winter Haven. (Octavio Jones for KFF Health News)
The cuts to agencies and research have affected parts of the federal government focused on students with disabilities. In March 2025, Trump signed an executive order to dismantle the Department of Education and closed seven of its Office for Civil Rights’ 12 regional offices. This June, his administration largely shifted special-education oversight to HHS and the Office for Civil Rights to the Department of Justice.
“On paper, it’s a reorganization,” said Nancy Potter, a former supervising attorney at the Office for Civil Rights who now runs her own education law firm. In practice, she said, it could leave families whose complaints involve overlapping harms — such as race and disability discrimination — caught between agencies built for different jobs. “The hardest thing to prove in these cases is now the thing with no obvious home.”
In April, a year after the order, a Senate committee report from Sen. Bernie Sanders (I-Vt.) concluded that the Office for Civil Rights had reached a 12-year-low in resolutions to discrimination complaints and had a backlog of nearly 12,000 civil rights cases. A recent Washington Post investigation found that the Trump administration “indefinitely froze” many of these cases.
On top of those cuts, the White House vowed to stop “equity” investigations in areas such as school discipline despite research showing that nonwhite and low-income kids disproportionately face barriers to being identified with autism and attaining resources for the condition and other neurodevelopmental diagnoses.
It also decimated the Institute of Education Sciences, the Department of Education’s research arm, canceling roughly $900 million in funding for research, including long-standing data collection in schools. The administration further proposed ending data collection on racial disparities in school discipline. The National Institutes of Health and National Science Foundation have purged projects referencing terms including “race” and “gender,” gutting research focused on diversity, equity, or inclusion.
“If we’re cutting any data collection that helps us understand the problem, we’re not going to fix it,” said Paul Morgan, director of the Institute for Social and Health Equity at SUNY-Albany, who led the studies on disparities in autism diagnoses. “All we’re doing right now is making the situation worse.”
The nation’s influential federal autism panel also appears to lack prominent scientists and Black members and has fewer autistic self-advocates than before, said Proctor of The Color of Autism Foundation, who served on the panel before the Trump administration took over. The panel has also been criticized for including vaccine opponents.
HHS’ Hilliard said the members “bring decades of experience in autism research and clinical care” and are committed to aligning “federal policy with gold-standard science.”
Disability advocates say federal officials are focused on the wrong priorities.
“All of it creates chaos where chaos is not necessary,” said Cameron Lynch, a former policy analyst for the Autistic Self Advocacy Network.
Josette Smith’s son was diagnosed with autism in kindergarten after displaying behavior that concerned his relatives: He paced, flapped his arms, and became consumed with highly specific interests, such as Martin Luther King Jr. and dachshunds. (Octavio Jones for KFF Health News)
Disability rights advocates fear the changes to special education oversight weaken the federal safety net for autistic students and others with disabilities, making these systems more confusing when families need help enforcing students’ rights.
David Sitcovsky, Autism Speaks’ vice president of advocacy, said families, especially those from marginalized communities, already often lack support for their children to receive a timely diagnosis or services in their school systems.
“The common thread across these issues is access,” Sitcovsky said. “If their child’s rights are not being upheld, do they have a clear path to get help?”
Smith awaits a decision about her federal civil rights case, which she was told could take more than a year amid the backlog, as Ethan has started fourth grade. She wants Ethan transferred to a school better equipped to support him. She has also requested an expedited hearing for a due process complaint she filed with the state.
The family is also navigating battery charges against Ethan, the first of which was filed in March after the school called police on him for allegedly hitting staff. A police report and an email provided by Smith showed that police arrived at her door hours after Smith informed the school district in writing that she had filed a federal discrimination complaint. Smith also pointed out the timing in several of her complaints.
A Polk County Public Schools spokesperson declined to comment, citing student confidentiality. The Florida Department of Education did not respond to a request for comment.
“As a Black mom, you dare not complain about anything,” Smith said. “Once you start advocating for your kids, it’s a problem. But it’s not these kids’ fault that they have a disability.”
Without timely assessments and interventions, studies show, children of color with disabilities such as Ethan are disproportionately at risk of being funneled out of public schools and into the juvenile and criminal justice systems.
Catherine Lhamon led the Education Department’s Office for Civil Rights in the Obama and Biden administrations and is now executive director of the Edley Center on Law & Democracy at the University of California-Berkeley School of Law. She said it’s a scary time for families who want to protect their children’s rights.
“People speed if they don’t see a police car,” Lhamon said. “If they think that there’s no one at the federal government watching them in school, we will see an increase in discrimination.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
According to researchers, upon interaction with Aβ, TZ-48undergoes changes in fluorescence intensity, which are captured and quantified the smartphone application.
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Kedaara Capital has acquired a majority stake in Tynor Orthotics for $200 million. This private equity firm is expanding its medical devices portfolio with this significant investment. Tynor Orthotics is a leading Indian manufacturer of orthopaedic and rehabilitation products. The company has a wide distribution network reaching many countries globally. Kedaara will partner with existing promoters and management to drive future growth.
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H1N1 accounts for nearly 98% of Influenza A cases currently detected in India, while H3N2 accounts for only 2-3%, Bahl said. He stressed that the rise was consistent with the seasonal pattern of influenza and did not indicate a new or more dangerous strain.
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In January, Jeff La Marca got a prescription for the popular weight loss drug Zepbound. But he couldn’t afford the $750 monthly price tag.
Then Medicare launched an 18-month pilot program that offers GLP-1 medications to some enrollees for only $50 a month. La Marca thought he might finally be able to afford the drug.
“I thought, ‘Thank God, there’s a path,’” said La Marca, who lives in Basking Ridge, New Jersey, and has tried numerous diets and exercise regimes.
But the 68-year-old’s celebration was short-lived.
His application to the pilot program was denied.
La Marca has severe obstructive sleep apnea, one of several diagnoses that exclude patients from the Bridge program’s $50 monthly price. The notification didn’t say why he was rejected. He thinks that if he didn’t have that diagnosis, he would qualify due to his weight.
“I’m obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I’m at risk for stroke. I’m prediabetic. And yet I can’t get it. I’m livid,” he said.
Jeff La Marca uses a machine to treat his obstructive sleep apnea. It adjusts his breathing with every breath. (Erica S. Lee for KFF Health News)
La Marca, a retired professor living in Basking Ridge, New Jersey, is among an estimated 5.9 million Medicare enrollees excluded from a GLP-1 discount program because they have a medical condition such as Type 2 diabetes or sleep apnea. (Erica S. Lee for KFF Health News)
A Temporary Patch for a Long-Standing Gap
About 1 in 5 American adults have taken a GLP-1 medication, and most of them, including those with health insurance, say the drugs are difficult to afford. Federal law has long barred Medicare from covering drugs prescribed solely for weight loss, which is why the Medicare GLP-1 Bridge program made a big splash when it launched in July.
It’s a short-term pilot program in which Medicare is offering coverage of three GLP-1s for weight loss and management, to see if that would save Medicare money later. Eligible patients must be enrolled in Medicare Part D, a prescription drug coverage add-on to Medicare. Even though people must have Part D insurance to qualify, the preauthorization request doesn’t go through the insurer; it’s instead submitted to a separate system run by a contractor for the Centers for Medicare & Medicaid Services.
The pilot includes Wegovy, the KwikPen formulation of Zepbound, and the oral medication Foundayo.
Under the pilot, many Medicare beneficiaries with a body mass index of 35 or higher — the upper range of obesity — qualify for coverage of one of those drugs, if prescribed. Those otherwise eligible who have a BMI of 27 to 34 can qualify if they also have certain health conditions, such as prediabetes or cardiovascular disease.
But buried in the fine print is a distinction that’s tripping up patients like La Marca: The $50 price under Bridge applies only to people using the drug solely for weight loss. Anyone who has a qualifying medical condition that the Food and Drug Administration has approved GLP-1s to treat, such as Type 2 diabetes or moderate to severe obstructive sleep apnea, is instead routed back to their Medicare Part D prescription drug plan, which can require copays of hundreds of dollars a month for GLP-1s.
“The Bridge program was designed to target those people who can’t get GLP-1 coverage through Part D but would benefit from taking one for weight loss,” said Juliette Cubanski, who directs the Program on Medicare Policy at KFF, a health information nonprofit that includes KFF Health News.
The cost to Medicare of subsidizing the drugs will depend largely on how many people use the program, and the federal government hasn’t released an estimate.
Cubanski has estimated that 3.8 million people qualify and that, if a quarter of them enroll in Bridge and remain on treatment for the program’s full 18 months, it will cost Medicare about $3.3 billion. If three-quarters enroll, costs could rise to $10 billion.
If the government expanded the program to include the additional 5.9 million people who are overweight and already eligible for GLP-1 coverage through Medicare Part D, it would add billions more to the program’s cost.
The demonstration’s initial weeks have been positive, and most prior authorization requests have been completed in under 12 hours, CMS spokesperson Timothy Foster said.
“This has allowed thousands of eligible beneficiaries to access GLP-1 medications for weight loss at pharmacies nationwide,” Foster said.
“I’m obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I’m at risk for stroke. I’m prediabetic. And yet I can’t get it. I’m livid,” La Marca says, referring to the popular weight loss drug Zepbound. (Erica S. Lee for KFF Health News)
GLP-1s Aren’t Covered
Patients like La Marca are left in a tough spot, qualifying for Part D coverage of a GLP-1 but facing much higher cost sharing.
“‘Coverage’ doesn’t always mean ‘affordable,’” said primary care physician Taylor Lacy, who describes herself as a “big proponent” of GLP-1s and practices at Sunflower Medical Group in Roeland Park, Kansas.
The Bridge program is leaving behind patients with the greatest medical need, she said. She noted that many Medicare patients already must navigate prior authorization and spend months trying alternate, often cheaper treatments, a process known as step therapy, before finally getting approval — only to arrive at the pharmacy counter and discover that their GLP-1 copays will run them $200 to $600 a month, if not more.
Researchers studying how Medicare insurers cover GLP-1s have found that recipients have faced increases in out-of-pocket costs and that almost all plans now require prior authorization, which can make getting the drugs more difficult.
Chris Bond, a spokesperson for insurance industry trade group AHIP, blamed drugmakers’ prices, “which they alone set and they alone can lower.”
La Marca’s insurer declined to answer specific questions about La Marca’s case.
Left Waiting
For now, La Marca’s GLP-1 prescription remains unfilled. The severe sleep apnea diagnosis that helps establish his medical need is also what excludes him from the discount program that would bring the cost within his reach.
As he reflected on his appeals and the dead ends, La Marca paused, his eyes filling with tears of frustration.
“This is now my quest, because it’s my only chance to improve my health,” he said. “It’s the only thing left. I’ve tried everything.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
