Why won’t Medicare cover effective obesity drugs?

The Centers for Disease Control and Prevention (CDC) estimates that more than one-third of adults in the United States are obese. A 2012 study published by the Journal of Health Economics found that the economic costs of obesity are tremendous, with Americans spending over $190 billion each year on obesity-related medical expenses. These costs go far beyond direct healthcare spending, as obesity contributes to short-term work absences, long-term disability, and premature death.

This month, the U.S. Food and Drug Administration (FDA) approved the third new prescription drug for obesity since 2012. Each of these medications are proven to help obese patients lose and manage weight, reducing risk of heart disease, diabetes, osteoarthritis, and other complications.

{mosads}With several drugs already on the market and others in the pipeline, we should expect access to these medications to begin reversing the alarming obesity epidemic, right? Not so fast.

Last year, the American Medical Association (AMA) formally recognized obesity as a disease. Since then, many private and public health programs, including the Federal Employee Health Benefits Program (FEHBP), now offer prescription drug coverage for obesity medications. Unfortunately, patients relying on Medicare Part D don’t receive the same benefits as most federal employees and those with private insurance.

Medicare Part D still prohibits coverage of FDA-approved obesity drugs, reasoning that these medications are subject to an exclusion from Medicare coverage for medicines used to treat anorexia, weight loss or weight gain. This inappropriate ban on coverage of obesity medications creates an unreasonable barrier for patient access to these important medicines, and is a disincentive for continued investment in obesity medicines-related R&D.

Changing current rules to allow Medicare Part D to cover obesity drugs could save the country billions of dollars in healthcare costs.

California Healthcare Institute (CHI) is excited about the promise these new therapies can offer to patients affected by obesity. While public health education and awareness campaigns have helped address adult obesity, California’s adult obesity rates remain high – approximately 25 percent of California’s adult population is affected by obesity. Effective management of obesity – through the use of medications combined with diet, exercise and other lifestyle changes – can help decrease the costs of obesity-related disability and other conditions in California and across the nation.

Without appropriate coverage and payment policies for these medications, patients will not have access to these lifesaving therapies. And without a robust consumer market, obesity-related therapeutic research pipelines will dry up, further restricting or removing treatment options for patients.

A solution is available in H.R. 2415, the Treat and Reduce Obesity Act. This legislation provides Medicare beneficiaries and their healthcare providers with meaningful tools to reduce obesity by improving access to weight-loss counseling and new prescription medications for chronic weight management, and provides real incentives to biopharmaceutical companies to innovate.

Sponsored by Reps. Bill Cassidy (R-La.) and Ron Kind (D-Wis.), the bill enjoys broad bipartisan support from 112 cosponsors. Enacting the Treat and Reduce Obesity Act is a common-sense step in the right direction toward helping curb a growing public health crisis.

As Congress seeks to reduce the cost of healthcare spending, increasing access to medications that will help halt one of the most costly chronic health conditions just makes good economic and public health sense. Passing this bill is a great way to start.

Carey is director of federal government relations and alliance development at California Healthcare Institute (CHI). CHI represents more than 275 leading biotechnology, medical device, diagnostics, pharmaceutical companies, and public and private academic biomedical research organizations.