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Three things create the gap: the retrospective prior auth design, the requirement to document BMI at the time of therapy initiation (a paperwork burden for beneficiaries who started GLP-1 therapy years ago for a different indication), and the exclusion of Private Fee-for-Service (PFFS) plans, PACE, and several other niche MA plan types from participation." Bridge and the ACCESS Model are both CMS efforts to reshape coverage for chronic and specialty conditions, but they operate at very different scopes and time horizons
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