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"In negotiating with participating manufacturers, CMS will consider the selected drug's clinical benefit, the extent to which it addresses unmet medical needs, and its impact on specific populations, including people who rely on Medicare, among other considerations, such as costs associated with research and development as well as production and distribution for selected drugs," the CMS fact sheet states.
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Coverage for obesity treatment is often determined by the specific plan design, employer group benefit decisions, and formulary inclusions rather than a universal coverage mandate
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