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PhRMA recently submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) proposed rule which would extend coverage of anti-obesity medicines (AOMs) in Medicare Part D and state Medicaid plans. Currently, AOMs are excluded from Medicare Part D coverage and optional in state Medicaid programs, when used specifically for the treatment of obesity, because they’re labeled as “agents used for weight loss.” However, this classification is outdated and lags behind medical science in the understanding of obesity as a serious chronic disease.
Obesity isn’t just about looks or cosmetics; it’s a serious chronic disease affecting over 40% of American adults. Two dozen leading health organizations, including the American Medical Association, have recognized obesity as a serious chronic disease over the past decade. Yet, Medicare and Medicaid coverage policies still don’t enable full access to medications that are FDA-approved, regulated and safe to treat it. These medications aren’t intended for people to just lose weight; they were developed and approved to treat obesity along with its hormonal and physiological consequences, much like how insulin manages diabetes and statins control cholesterol.
CMS’s recognition of obesity as a chronic disease could make a significant difference for patients and provide meaningful savings to our health care system. Over the next decade, Medicare and Medicaid are projected to spend $4.1 trillion on treating obesity and obesity-related chronic diseases alone. Beyond direct health care costs, obesity has a considerable impact on our economy, with an estimated total cost of $1.72 trillion annually, including $481 billion in direct medical expenses and $1.24 trillion in lost productivity. By reducing the prevalence of obesity, we prevent the burden of chronic disease, improve the quality of life for millions of Americans and even save our health care system money in the long run.
There is strong evidence that preventive medicines for chronic diseases can decrease overall health care spending growth.
- For example, between 1999 and 2012, slower Medicare spending growth translated into significant savings, with research showing that one-quarter of the slowdown can be attributed to greater uptake of cardiovascular medicines that helped prevent costly complications.
Moving forward, AOMs could have a similarly transformative impact.
- One analysis found that in Medicare, just a 5% reduction in weight for individuals with obesity could reduce annual health care spending by $1,262 per person, while a 25% reduction could save $5,442 per person annually.
- And another analysis estimated that increased use of GLP-1 medications for chronic obesity could add as much as 1% to U.S. GDP over the next four years by reducing health issues like heart attacks, strokes and diabetes.
- Furthermore, the USC Schaeffer Center estimated expanding coverage for AOMs could offset approximately $175 billion in Medicare costs over the next 10 years. Over a 30-year period, these savings could grow to an impressive $700 billion.
Along with lifestyle changes and other interventions, AOMs provide a path forward that focuses on preventing disease rather than just managing its symptoms and bearing its costly consequences. Expanding coverage would allow patients to better manage their condition, leading to fewer emergency room visits, hospital stays and costlier interventions later down the line. It’s time for CMS to recognize obesity for what it is –– a chronic condition impacting millions of Americans –– and ensure patients have access to the approved treatments they need.
Read PhRMA’s full comment letter here.
Matthew Norawong
Matthew is a senior manager on PhRMA’s Public Affairs team focusing on Medicare, Medicaid, importation and more. Prior to coming to PhRMA, he previously worked as a health policy analyst for National Journal’s Network Science Initiative, primarily supporting companies in the life sciences industry. Matthew completed his undergraduate studies in political science at the University of Washington and subsequently earned a Master of Public Health from the George Washington University. A native of the Pacific Northwest, Matthew currently resides in Washington, DC. Outside of the office, Matthew is an avid runner and enjoys playing bass guitar with his indie rock band.
Matthew Norawong
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