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Regulators are concerned that making the medicine widely available could lead to: Misdiagnosis: Patients self-treating a different, underlying condition

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If you need weight loss through appetite suppression, Semaglutide (Ozempic) is superior

Another commenter indicated they had not encountered any scenarios where a known fee schedule, case rate, or per diem exists outside of a more complicated and detailed algorithm and provided examples of factors that may further modify a fee schedule, case rate, or per diem, including carveouts, lesser of methodology, stop loss provisions, exclusions, and grouper logic

Impacts of all OPPS Changes Table 167 in section XXVI.C

(November 2017)