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After consideration of the public comment we received, we are finalizing our proposal, without modification, to continue to our policy of estimating outlier payments to be 1.0 percent of the estimated aggregate total payments under the OPPS and to use our established methodology to set the OPPS outlier fixed-dollar loss threshold for CY 2026
GLP-1 therapy can be reconsidered once psychiatric symptoms are managed
In the Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes (SUSTAIN) clinical trial programme, semaglutide 1 mg was associated with greater reductions in glycated haemoglobin (HbA1c) and weight than exenatide extended-release 2 mg [7], dulaglutide 1.5 mg [8] and liraglutide 1.2 mg [9]
In contrast, oral application is compatible with daily, timed use which is more likely to achieve normal physiological effects
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