What They’re Saying: CMS’ Proposal to Expand Medicare and Medicaid Coverage for Obesity Medications

Following the Centers for Medicare & Medicaid Services’ (CMS) recent proposal to expand coverage of obesity management medications for weight loss for Medicare and Medicaid beneficiaries, leading experts have expressed support for expanded coverage, arguing that it would provide necessary access to obesity management medications for millions of people living with the disease – and who currently face significant barriers to care.  

Prominent voices ranging from healthcare advocates to providers, academics and policy experts emphasize that this change would mark an important step in recognizing obesity as a chronic disease, paving the way for more effective care and ultimately, a healthier population.    

Highlights are included below: 

“Anything short of complete coverage is unfair to the millions of people with obesity who could benefit from safe and effective obesity medications. Recognizing obesity as a chronic disease will ease the burden on individual patients by providing them with the critical care they deserve while strengthening the health care system by improving outcomes as people age.” – Anand Parekh, MD, Bipartisan Policy Center; William Dietz, MD, Ph.D, Milken Institute School of Public Health, George Washington University, and STOP Obesity Alliance; and Joseph Nadglowski, Obesity Action Coalition (STAT News)  

“This proposed rule signals an important shift in the federal approach to obesity management, aligning with the medical community’s consensus that obesity is a chronic disease requiring long-term care. It also highlights the economic and ethical imperative of addressing obesity proactively, rather than reactively.” – Joseph Zucchi, PA-C, MPAS, Transition Medical Weight Loss (MedPage Today)  

“While it will take time to fully realize some of the health benefits and cost offsets from reductions in obesity-related conditions (e.g., diabetes, heart disease, sleep apnea, cancer) and see the beneficial impact of these drugs on other non-obesity-related conditions (e.g., alcohol and other substance abuse), expanding access for these highly effective obesity medicines to Medicare beneficiaries and paying for them by competitive price reductions, judicious use, and reducing the billions of taxpayer dollars spent in the US annually on unnecessary care, can help make Americans Healthier (again) and not break the federal bank.” – A. Mark Fendrick, MD, University of Michigan Center for Value-Based Insurance Design; Kirsten Axelsen, American Enterprise Institute (RealClear Health)  

“The current policy is hypocritical. It creates an exemption for medicines that promote weight gain when used for noncosmetic purposes but does not offer the same exemption for weight loss for noncosmetic purposes. Whether through the proposed CMS rule change or a bill in the current Congress – the Treat and Reduce Obesity Act of 2023, which would expand coverage to weight-loss drugs when medically necessary and not for cosmetic reasons – Washington must act soon to help patients.” – Sally C. Pipes and Wayne Winegarden, Pacific Research Institute (The Washington Times)  

“The Joint Economic Committee estimates government spending on obesity will exceed $4 trillion by 2033. We must reduce these costs, and done right, expanding access to obesity medications can help make a real dent and improve life for millions of Americans.”  – Joe Grogan, University of Southern California Schaeffer Institute (STAT News) 

The Alliance for Women’s Health and Prevention (AWHP) has submitted comments to CMS in support of the proposal, available here.  

To learn more about CMS’ proposed rule, click here.