House Appropriations Calls for Obesity Meds in Medicare

Okay, this is hardly a final victory, but it sure does feel good. The U.S. House Appropriations Committee released its legislative report on funding for Health and Human Services. It’s a beastly 623 page document that goes over all the spending priorities for the department. However, if you dig deep into it, there’s a paragraph that “encourages CMS to ensure access to treatments for obesity in Part D” of Medicare. For years, CMS has excluded coverage of obesity meds from Medicare drug plans, calling them “weight loss drugs” that can be excluded.

But the committee says it plainly. The statutory exclusion of agents for weight loss “does not include an FDA-approved anti-obesity agent” as classified by the USP.

Compelling Reasons

In the section that covers this question, the reasoning is quite clear. It’s important because “access to obesity treatment, including anti-obesity medication is an important part of the Administration’s effort to combat chronic disease, reduce health care costs and improve care.”

The document goes on to say that Medicare covers bariatric surgery and intensive behavioral therapy. So it makes sense to cover the drugs that are rapidly improving to help people overcome this disease. The committee also points out that obesity is a factor in more than 200 other health conditions and it drives poor outcomes in heart disease, Alzheimer’s, diabetes, cancer, and COVID-19.

Finally, the committee writes that obesity is a disease that disproportionately harms communities of color. So if the government wants make good on its promise to advance racial equity, covering obesity meds in Medicare makes eminently good sense.

A Stubborn Bureaucracy

Will this report change things? By itself, right now, probably not. The bureaucracy of Medicare moves very slowly and it has a whole labyrinth of policies that make it hard to get most evidence-based care for obesity. The one long-standing exception is bariatric surgery.

But this does mark progress. It tells us that the message about treating obesity is starting to penetrate the bureaucracy. An Israeli diplomat, Abba Eban, once pointed out that people and their governments eventually do the right thing, after first exhausting all the other possibilities. We suspect that this will be true in coverage of obesity meds. We are making progress in that direction.

Click here for the committee report and here for coverage of it in the Pink Sheet. For further perspective on coverage for obesity care, click here.

Science in the Apotheosis of Washington, photograph by the Architect of the Capitol / Flickr

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June 30, 2022