Modernize Medicare by Covering Anti-Obesity Medications
Obesity is a serious health problem for millions of Americans and for our nation where 42% of US adults are living with obesity. The association with other chronic conditions, including heart disease, stroke, and Type 2 diabetes, is incontrovertible.
Obesity also has been identified as one of the greatest risk factors for severe COVID-19 infection and death, and its burden does not fall equally on all communities. It is a particularly significant concern for communities of color.
A newer generation of innovative anti-obesity medications (AOMs) is emerging that can provide another treatment option for those living with obesity. But not all health plans cover these drugs, and under current law, few seniors have access to them through Medicare.
Medicare already is going broke, but its bankruptcy will be accelerated if it continues to pay for care only to treat diseases instead of allowing a broader range of treatment options to help get and keep people healthy.
Both political parties stress their commitment to Medicare, and it is important 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 creation of the Medicare drug benefit in 2003, he argued Medicare needed to be reformed “because it did not provide prescription drug coverage.”
“Medicare would pay for a surgery, say, like ulcer surgery, for $28,000,” he said, “but wouldn’t pay $500 for the prescription drugs that would have prevented the ulcer in the first place.” Mr. Bush argued that “medicine had changed with the advent of prescription drugs, but Medicare hadn’t.”
The Medicare Modernization Act (MMA) passed in 2003, and the Medicare Prescription Drug Benefit (Part D) program it created began covering seniors in 2006.
But the legislation banned coverage for medicines or classes of medicines “when used for anorexia, weight loss, or weight gain.” And the ban still stands.
So today, 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 is bad public health policy, and it is inconsistent with a focus on care management and disease prevention. It also 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.
There is no time to waste, especially since we know that Americans with obesity are much more susceptible to the kinds of global contagions the world has just gone through with COVID-19.
A study by Xcenda, a life-sciences consulting firm, reports that if the obesity rate were 25% lower, COVID deaths and ICU admissions would have been reduced by 11.5% and hospitalizations would have been reduced by nearly 7%.
An unlikely alliance of groups is coming together to urge Congress to allow coverage of anti-obesity medications in Medicare. “It’s not every day that the pharmaceutical industry, the NAACP, a cancer center, and a nonpartisan think tank are all lobbying to achieve the same policy goal,” an article in STAT reads. “But an effort to expand Medicare coverage for obesity drugs has managed to unite them all, and many more groups across the health care industry, too.”
The American public is listening: They rated obesity as the second greatest threat to public health, after opioids and fentanyl in a recent Axios-Ipsos American Health Index survey.
Outdated regulatory policies reflect antiquated thinking as if this is simply about lifestyle choices for people who want to lose a few pounds on the latest “diet drugs.” As a result, physicians are limited in their options to treat patients who may have struggled with obesity for years or even decades and for whom recommendations for improved diets and exercise simply don’t work.
Updating Medicare to enable seniors living with obesity to get the care they need would be a welcome gift to beneficiaries to celebrate this year the 20th anniversary of passage of the Medicare prescription drug benefit. Several experts believe that Medicare Advantage plans would find it beneficial to cover AOMs, alongside other obesity treatment measures, and that they would be most attentive to managing the benefit.
Commercial insurers also often follow Medicare’s lead, so if Medicare were to cover AOMs, access would likely improve for people who get their insurance at work, giving employers another tool to address one of the causes of rising health costs.
Prevention saves money and lives. As the obesity problem grows, patients should be able to choose for themselves, in consultation with their physicians, from a full range of treatment options, including innovative anti-obesity medications.
Grace-Marie Turner runs the Galen Institute to advance public policy ideas that advance patient-centered health care. @gracemarietweet. She can be reached at galen@galen.org. Read more in her study, 'Modernize Medicare by Covering Anti-Obesity Medications.'
