Medicare Part D must start covering anti-obesity medications

Between 2017 and 2020, nearly half of all Americans were living with obesity. As the prevalence and impact of this complex condition has grown, so too has our understanding of how to treat the disease effectively for patients.

Because obesity is a complex condition, we must treat it as such — with the full range of evidence-based therapies. Yet despite indisputable evidence regarding the positive health impacts of treating obesity, one of the nation’s largest health programs lags behind the science, prevailing clinical guidelines, and other federal agencies by not covering comprehensive obesity care.

To address the obesity epidemic among senior populations and recognize obesity as the disease it is, the Centers for Medicare and Medicare Services (CMS) must expand obesity care and provide coverage of anti-obesity medications in Medicare Part D.

Obesity is a complex, chronic disease that affects virtually every system in the body. The disease is characterized by an excess accumulation of body fat that harms health. Individuals who have obesity are at increased risk for many serious conditions and health complications, including hypertension, type-two diabetes, coronary heart disease, stroke, and many types of cancer. 

The leading causes of preventable death in the U.S. are all linked with obesity. These diseases not only exact a significant toll on individuals and families, but pose an economic burden as well. Heart disease and stroke alone costs the American healthcare system $216 billion per year. In 2022, direct medical costs of diabetes reached over $300 billion.

Over time, our understanding of the disease and how to effectively treat and manage obesity has evolved with the changing science. Over the last three decades, breakthrough innovations have led to the development and government approval of a new, safe and effective medicines for long-term treatment of obesity as part of a comprehensive obesity treatment strategy.

These treatments have been shown to be highly effective in treating obesity and related health problems. Specifically, the current generation of anti-obesity medications have demonstrated efficacy against both the progression to diabetes and cardiovascular disease risk factors. Groundbreaking research released this year demonstrated that these treatments can reduce the risk of heart attacks and strokes by 20 percent in adults with heart disease and obesity.

As science has changed the obesity treatment landscape, states and federal agencies have recognized the imperative to cover anti-obesity medications. The U.S. Food and Drug Administration (FDA) recently announced its intention to update its guidance for anti-obesity drug development. Today, more than a dozen states across the country cover at least one such FDA-approved drug under Medicaid.

The U.S. Departments of Defense and Veterans Affairs, and the federal Office of Personnel Management have all taken action to provide coverage for anti-obesity medications in combination with lifestyle, behavioral, and surgical interventions. And this November, the American Medical Association adopted a new policy that calls for insurance coverage parity for emerging obesity treatment options.

CMS lags behind the evidence and the progress of states and other federal agencies, failing to cover anti-obesity drugs in Medicare Part D. CMS bases this refusal on its interpretation of an outdated federal statute which excludes “agents when used for anorexia, weight loss, or weight gain” from Part D coverage. Yet CMS has previously altered its interpretation of the law to allow coverage of drugs that treat cachexia, causing weight gain. By simply applying this same legal interpretation to medications used to treat obesity, CMS could instantly remove its self-imposed prohibition.

By 2030, experts expect that 50 percent of Americans will be living with obesity. CMS must act now to eliminate barriers to comprehensive obesity care, including effective FDA-approved medicines that are proven to treat obesity. CMS has the authority and precedent to do so, and should do so at a moment that is calling for it.

Joseph Nadglowski is president and CEO of the Obesity Action Coalition. Anthony Comuzzie is CEO of the Obesity Society.