Self-Administered Drug Exclusion List (A53032) - R35 - Effective June 23, 2024

Date Posted: May 9, 2024

This coverage article has been revised and published for notice under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: June 23, 2024

Summary of Changes:

The article has been updated to add brand names to the SAD list under their respective generic names for the following drugs:

Semaglutide: Ozempic, Wegovy

Tirzepatide: Mounjaro, Zepbound

The addition of the above mentioned brand names is effective 06/23/2024.

The article has also been updated to apply consistent formatting for drug names. The new format applied is "generic name (brand name)". This formatting update does not change any coverage or guidance.

Visit the Self-Administered Drugs (SADs) webpage to view the Self-Administered Drug Exclusion List.

To view the complete listing of coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD, visit the Medicare Coverage Articles webpage.

Last Updated May 09 , 2024