Medicare should cover anti-obesity drugs

OPINION:

The Centers for Medicare & Medicaid Services has proposed a rule expanding Medicare and Medicaid patients’ access to anti-obesity drugs such as GLP-1s. Congress is also considering such a move. Expanding coverage to these patient groups makes sense.

Obesity is “a common, serious, and costly chronic disease,” according to the Centers for Disease Control and Prevention. More than 200 coexisting conditionsare  associated with obesity, including high blood pressure, Type 2 diabetes, coronary heart disease, certain cancers and asthma. The disease costs the U.S. health care system around $173 billion annually.

Beyond the health care system, obesity reduces people’s productivity, which adversely affects economic growth. Global economic impact estimates show the U.S. economy may be more than 2% smaller because of obesity.

There are also national security implications. The CDC notes that “only 2 in 5 young adults are weight-eligible and physically prepared for basic training” in the military because of obesity.

Studies have demonstrated that anti-obesity medicines can effectively treat the disease by helping patients lose significant amounts of weight, which makes it logical to ensure that Medicare and Medicaid patients have access to these medicines.

Covering obesity medication would also reduce overall health care spending. With obesity under control, patients will need fewer expensive surgeries, hospital stays and other medical treatments. Lowering health care expenditures is particularly important, considering the $1.7 trillion spent by the Medicare and Medicaid programs.

For instance, a 2023 study by the University of Southern California’s Schaeffer Center for Health Policy and Economics found that “in the first 10 years alone, Medicare coverage of weight-loss therapies would save the program $175 billion to $245 billion, depending on whether private insurance also covers the treatments. Over 60% of these savings would accrue to Medicare Part A by reducing hospital inpatient care demands and the demand for skilled nursing care.”

A 2024 study in the American Journal of Managed Care found that patients’ health care costs declined by $7,502 after they began treatment with the anti-obesity drug semaglutide.

Importantly, the study found that “these reductions in medical costs occurred despite the additional cost of the semaglutide treatment itself, which is known to be expensive. This suggests that the clinical benefits of semaglutide, including weight loss and improvement in [heart failure] symptoms, may lead to fewer hospital admissions, fewer outpatient visits, and less frequent use of emergency services, ultimately reducing overall health care costs.”

Not covering a medicine that improves patient outcomes and reduces overall health care spending is clearly foolish. Yet a current federal law, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, stands in the way. The law prohibits Medicare from covering drugs used for weight loss, anorexia or weight gain. The decision was made based on the safety concerns of several older drugs, such as fen-phen, and the notion that they were used mostly for cosmetic reasons. These considerations are inapplicable to the current anti-obesity medicines.

Medicare, however, does cover medically necessary weight-gain drugs to treat patients living with physical wasting disease. These patients are afflicted with advanced-stage cancer, heart disease and HIV and experience rapid, unexplained weight loss of 5% or more, muscle atrophy and fatigue.

Under current law, Medicare distinguishes between weight management drugs for medically necessary reasons, which are covered, and cosmetic reasons, which are not. Yet current policy does not cover anti-obesity drugs, “even if used for non-cosmetic purposes.”

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.

There are large potential health benefits to patients and net savings for the health care system from covering anti-obesity drugs that justify revising the anachronistic rules constraining Medicare’s ability to improve overall health outcomes.

• Sally C. Pipes is president, CEO and Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Wayne Winegarden is senior fellow in business and economics at the institute and director of its Center for Medical Economics and Innovation.