No, the Door Is Not Closed on Obesity Medicines at CMS
As everyone digests the news that CMS has chosen not to expand coverage of obesity medicines under Medicare and Medicaid “at this time,” it is becoming clear the door is not closed. HHS told Bndpoints News:
“CMS may consider future policy options for obesity medications pending further review of both the potential benefits of these drugs including updated clinical indications, and relevant costs including fiscal impacts on stakeholders such as state Medicaid agencies,”
A Return on Investment
This brings to mind the striking relevance of a new analysis from the USC Schaeffer Center for Public Policy. Economist Alison Sexton Ward and colleagues found a substantial return on investment from covering obesity medications under Medicare and Medicaid. Writing in the Washington Post this week, Ward and her colleague Dana Goldman explained:
“Using a microsimulation model, we and our colleagues at the University of Southern California’s Schaeffer Center for Health Policy & Economics found that widespread access to the drugs would have extraordinary benefits to society. People who begin treatment between the ages of 25 and 34 could gain as much as 1.8 years of life, spend nearly six fewer years with diabetes, and reduce the risk of hypertension, heart disease, stroke and cancer. Even those who start treatment later in life, between 65 and 74, could expect to live about six months longer and experience reduced time living with diabetes.”
A Senator’s Personal Experience
On top of that, we have Senator John Fetterman speaking up. He writes in the New York Times that more Americans need access to these drugs. He explains how he has personally benefited from taking tirzepatide:
“Even though I started taking it for my heart health, I’ve been struck by how much better it has made me feel across the board. It’s made a significant impact on my overall health. Aches, pains and stiffness have vanished. Physically, I feel a decade younger, clearer-headed, and more optimistic than I’ve been in years. As far as a side effects, I’ve also lost around 20 pounds.”
Of course, these are serious drugs that require careful use. But right now, such use is not even possible for many people in Medicare and Medicaid because those programs will not cover the expense.
This is wrong. It makes people sicker and ultimately, as the USC analysis shows, drives up human and financial costs by harming their health.
Click here for the analysis by Sexton Ward, and here for her opinion piece in the Post. For the essay by Fetterman, click here.
Doorway, painting by Marcus Stone / WikiArt
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April 9, 2025
