Why doesn’t Medicare cover obesity drugs?

Estimates by the Centers for Disease Control and Prevention show that more than 1/3rd of the adults in the US are obese. A study published by the Journal of Health Economics in 2012 found that the economic costs associated with obesity are great and Americans tend to spend more than $190 billion every year on medical expenses related to obesity. These costs are much beyond direct health care spending because obesity causes absences from work, long term disability and may even lead to premature death in some cases.
The FDA has also approved the 3rd new prescription drug to be used for obesity since 2012. Each of these medications which have been approved have been proven to help obese individuals lose as well as manage their weight along with reducing their risk for heart diseases, osteoarthritis, diabetes and other related complications.
With a number of drugs already available and a number of others in the pipeline, one should expect that having access to these medicines should begin to reverse the effects of the obesity epidemic right? However this isn’t the case.
Last year, the AMA formally recognized obesity to be a disease and since then a number of public and private health programs have begun to offer prescription drug coverage for medications used to treat obesity. For those patients who are relying on the Medicare Part D plan unfortunately do not receive this same benefit as do federal employees and those who have private insurance.
Medicare Part D does not allow the coverage of FDA approved obesity drugs and gives the reasoning that these medicines are subjected to be excluded from the Medicare coverage for medications which are used in treating weight loss, weight gain or anorexia. Thus such an inappropriate ban on the coverage of medicines for obesity tends to create an unreasonable barrier for those patients requiring access to these medicines. By changing the present rules to allow the Part D Medicare to cover obesity drugs could help in saving the country large amounts of money in terms of health care costs.
Without the required coverage and payment policies derived for such medication, patients won’t be able to have access to such therapies which could save lives. Furthermore without a consumer market, research which is in the pipeline will also dry up which would further restricts and removes the treatment options available for patients.
A possible solution is found in H.R. 2415 which is the Treat and Reduce Obesity Act. This legislation allows Medicare beneficiaries as well as their health care providers with the tools needed to lower obesity by improving the access they have to weight loss counseling as well as new prescription medicines for the management of chronic weight and also provides incentives for bio-pharmaceutical companies to continue innovating.
With Congress looking to reduce the costs associated with health care spending, increasing the access to medicines which will help in halting one of the most chronic health related conditions actually makes economic and public health sense. The passing of this bill would thus be a good way to start.


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