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Prior authorization requirements, step therapy protocols requiring failure of other medications first, and body mass index thresholds create additional barriers

In the CY 2026 PFS proposed rule, we also noted that the QP thresholds have increased relative to previous years and, effective with the 2025 QP Performance Period are now at 75 percent for the payment amount and 50 percent for the patient count

Common Questions GLP-1 Cost & Coverage FAQs How much does GLP-1 medication cost with Medicare