RBC sees little cause for concern over CMS’ proposed part D GLP-1 coverage rule

RBC Capital sees little reason for concern over CMS’ proposed GLP-1 coverage rule and its potential impact on MCOs. Should the rule go into effect in 2026 as proposed, plans would have adequate opportunity to price for any increased utilization related to the anti-obesity indication, the firm adds. Even if for some reason the anti-obesity indication were to take effect before inclusion in bids, CMS protects plans from undue cost burden through policies like significant cost thresholds that limit losses until the new indication can be adequately reflected in bids, RBC notes. As such, the firm would not expect too much of an MCR headwind even if Tuesday’s proposal survives the administration change and is implemented as proposed. The drugs covered under the new proposed coverage rule would include Wegovy from Novo Nordisk (NVO) and Zepbound from Eli Lilly (LLY). Publicly traded MCOs include CVS Health (CVS), UnitedHealth (UNH), Humana (HUM), Centene (CNC) and Cigna (CI).