Medicare's Move to Cover Anti-Obesity Meds: Boosting Health, Cutting Costs
Obesity has become a significant public health concern in the United States, affecting millions of Americans and posing a serious threat to the overall health of the nation. According to the Centers for Disease Control and Prevention (CDC), 42% of US adults are living with obesity, with rates highest among non-Hispanic Black adults and Hispanic adults.
Obesity is associated with a range of chronic conditions, including heart disease, stroke, Type 2 diabetes, and certain types of cancer. Moreover, it has been identified as one of the greatest risk factors for severe COVID-19 infection and death. The burden of obesity does not fall equally on all communities, with people of color experiencing disproportionately higher rates of the condition.
In recent years, a newer generation of anti-obesity medications (AOMs) has emerged, providing another treatment option for those living with obesity. However, not all health plans cover these drugs, and under current law, few seniors have access to them through Medicare.
Medicare is facing financial challenges, and its bankruptcy could be accelerated if it continues to pay for care only to treat diseases instead of allowing a broader range of treatment options to help people get and stay healthy. Therefore, covering AOMs would be an essential step towards improving the health of the Medicare population and reducing overall medical costs.
Both political parties emphasize their commitment to Medicare, and it is vital to identify ways to improve the health of the Medicare population to reduce overall medical costs. Covering AOMs would be an important step in that direction. When former President George W. Bush promoted the creation of the Medicare drug benefit in 2003, he argued that Medicare needed to be reformed because it did not provide prescription drug coverage.
The Medicare Modernization Act (MMA) passed in 2003, and the Medicare Prescription Drug Benefit (Part D) program it created began covering seniors in 2006. However, the legislation banned coverage for medicines or classes of medicines "when used for anorexia, weight loss, or weight gain." And the ban still stands. As a result, Medicare will pay for expensive bariatric surgery, the last-resort treatment for obesity, as well as treatments for more than 200 comorbidities linked to obesity, such as certain cancers, dementia, and Alzheimer's disease, but not for new treatments that scientists have developed that can address the disease itself. This approach is inconsistent with a focus on care management and disease prevention, and it imposes a substantial fiscal burden on the nation. Research consistently shows a strong correlation between obesity and higher medical expenditures.
A study by Harvard University researchers found that annual medical costs for adults living with obesity were $1,861 higher than medical costs for people of healthy weight and $11,481 higher for people with severe obesity. A study by Brookings Institution scholars found that people living with obesity have nearly 36% higher average annual health costs compared to healthy-weight individuals.
As the medical and scientific communities evolve in understanding and treating obesity, the standard of care also needs to evolve. In 2013, the American Medical Association House of Delegates voted to recognize obesity as a disease state requiring treatment and prevention efforts.
Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans," Dr. Patrice Harris, a member of the association's board, said following the AMA vote. The American Association of Clinical Endocrinologists, the American College of Endocrinology, and the American Gastroenterology Association all have published clinical practice guidelines to diagnose, manage, and treat obesity that includes the use of AOMs.
It is essential to act now, especially since Americans with obesity are much more susceptible to the kinds of global contagions the world has just gone through with COVID-19.