On November 26th, 2024, the Biden-Harris administration issued a proposal for the expansion of Medicare coverage, specifically under Medicare Advantage and Medicare Part-D. The proposal speaks on an intention to lower drug costs under the plans, but also specifically proposes the coverage of anti-obesity medications (AOMs) for Medicare recipients. It is currently set for the 2026 Contract Year, and is of course yet to be approved.
“In recognition of the prevailing medical consensus that obesity is a disease, CMS is proposing to reinterpret the statute to no longer exclude anti-obesity medications for the treatment of obesity from coverage under Medicare Part D and to require Medicaid programs to cover these medications when used to treat obesity,” from The Centers for Medicare & Medicaid Services (CMS), on the Biden-Harris Administration’s proposal.
The National Hispanic Council on Aging has long advocated for the coverage of AOMs for Medicare recipients, like many other organizations within the field of aging. NHCOA supports this proposal and its overt intention to both lessen the financial burden on older adults, as well as to better alleviate the strain on daily health experienced by many older adults who experience obesity. Outside of this proposal from the White House, many organizations concerned with the health of older adults and/or the obesity epidemic have advocated for this expansion via the Treat and Reduce Obesity Act (TROA).
Why is AOM coverage important?
When it comes to treating obesity, most of us will think of physical activity and nutrition therapy. However, there is a much broader continuum of care than just exercising more and following a healthy diet, including pharmacotherapy, the use of prescribed medications such as anti-obesity medications (AOMs).
Many of these medications have already been approved by the US Food and Drug Administration, but are currently not covered by Medicare. This leaves Medicare beneficiaries with either no access to these drugs, or with the financial burden of paying completely out of pocket. Nutrition therapy, behavioral therapy, and physical activity are certainly important aspects of treatment for obesity, but they often just aren’t enough, leaving obese patients with severe health risks and financial strain.
Even nutrition therapy is often incredibly hard to follow or maintain. Healthy foods can be expensive, and often even inaccessible to certain areas. For more information, see our previous post on Food Insecurity, here.
Obesity is not just the result of bad habits, it’s a disease.
Just as CMS has stated, obesity has come to be recognized as a disease. In fact, the Centers for Disease Control and Prevention (CDC) refers to obesity as “a common, serious, and costly chronic disease.” Those living with obesity are managing an ongoing and worsening condition, which poses severe risks to their overall health and will likely accrue other conditions due to that risk. According to the CDC, obesity heightens the risk of such other chronic diseases as type-2 diabetes, arthritis, asthma, sleep apnea, and cardiovascular disease (CVD).
CVD is the leading cause of death in both men and women in the United States. The CDC reports that 58% of adults with obesity in the US have high blood pressure, putting them at great risk of developing CVD, and that 23% of obese adults have been diagnosed with diabetes. These other chronic diseases aren’t just worsening the quality of life for obese individuals, but adding more and more medical fees to manage.
Expanding coverage of Medicare to include AOMs isn’t just a big step forward for the obesity epidemic. It has the potential to create a dramatic improvement to the lives of over 40% of the country, from their quality of life to their wallets.
References:
– “FACT SHEET: Biden-Harris Administration […],” Briefing Room, Statements and Releases. The White House. 11/26/2024. https://www.whitehouse.gov/briefing-room/statements-releases/2024/11/26/fact-sheet-biden-harris-administration-takes-latest-step-to-lower-prescription-drug-costs-by-proposing-expanded-coverage-of-anti-obesity-medications-for-americans-with-medicare-and-medicaid/
– “Biden-Harris Administration Announces […],” Newsroom, Press Releases. Centers for Medicare & Medicaid Services. 11/26/2024. https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-medicare-advantage-and-medicare-part-d-prescription-drug
– “Adult Obesity Facts,” Obesity. The Centers for Disease Control and Prevention. 5/14/2024. https://www.cdc.gov/obesity/adult-obesity-facts/index.html
– “About Obesity,” Obesity. The Centers for Disease Control and Prevention. 1/23/2024. https://www.cdc.gov/obesity/php/about/index.html
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