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Commission approves biosimilar management approach; GLP‑1s limited to diabetes coverage
Summary
A consent amendment to the city's pharmacy-benefit management will move the plan to an automated biosimilar‑management program preferring FDA‑approved biosimilars over brand biologics; the amendment also clarifies GLP‑1 coverage will continue for diabetes indications but excludes use solely for weight loss.
City staff outlined a consent amendment to the medical- and pharmacy‑benefits administrator contract that would move the plan from drug‑by‑drug biosimilar updates to an ongoing biosimilar-management program. Under the change, FDA‑approved biosimilars would be added as preferred alternatives and the brand biologic would be excluded where appropriate to control specialty-drug cost growth.
The amendment also clarifies coverage for GLP‑1 medications: the plan will continue coverage for diabetes and related clinical indications, but the city will not cover GLP‑1s when prescribed solely for weight management. Commissioners asked staff to confirm Medicare and TRICARE coverage expansions for some GLP‑1s; staff said they would check and follow up. One participant described positive customer-service experiences with the pharmacy program's specialty-drug supports.
