Sens. Bill Cassidy (R-LA) and Tom Carper (D-DE), along with Reps. Brad Wenstrup (R-OH) and Raul Ruiz (D-CA), are introducing the Treat and Reduce Obesity Act, or TROA, in both chambers of Congress on Thursday, an effort to expand chronic obesity medication and treatment to Medicare recipients.
“There is a clear need to address obesity,” Cassidy, the ranking member of the Senate Health, Education, Labor, and Pensions Committee, said. “Expanding Medicare coverage to the treatments patients need enables them to improve their health and benefits us all.”
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According to the bill, an estimated 41% of Americans over the age of 60 were obese in 2015, and the National Institutes of Health reported that 300,000 deaths per year are attributable to the obesity epidemic.
“On average, a Medicare beneficiary with obesity costs $2,018 (in 2019 dollars) more than a healthy-weight beneficiary,” reads the bill, with the “direct and indirect costs of obesity” being nearly $428 billion in 2014.
“With obesity rates on the rise in our country, we must do more to combat this epidemic head-on,” Carper said. “Too many of those in need are being denied care because of the high cost of medications or inaccessible treatment options.”
TROA would extend coverage for intensive behavioral therapy to intensive behavioral therapy for treating obesity that can be administered either by a physician or by physician referral to a hospital or community-based counseling program.
The bill would also expand Medicare Part D coverage to include drugs such as Wegovy, which is prescribed on-label for weight loss, and Ozempic, which has grown in popularity in recent months as a weight loss drug.
Novo Nordisk, the maker of both Ozempic and Wegovy, hired a lobbying firm in May to push for the drugs to be included in Medicare coverage for the purposes of weight loss and obesity management. Ozempic is currently only covered by Medicare for Type 2 diabetes treatment, as per its Food and Drug Administration approval.
Carper has worked with multiple stakeholders since 2013 to expand obesity medicine coverage, including medication and behavioral treatments and preventive care.
Recent research published in Nature Metabolism suggests that obesity changes the way the brain processes nutrient intake, with an imbalance between the gut and the brain leading to overeating and not feeling full.
Angela Fitch, the president of the Obesity Medicine Association, previously told the Washington Examiner that obesity should be recognized as a disease state and, as such, medications ought to be covered as a standard benefit by health insurance, including Medicare.
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“If you ask 10 people on the street, ‘How do you treat breast cancer?’ … I guarantee there’s not going to be one person who says you can just will it away,” Fitch said.
“We cannot stand idly by while this disease continues to claim lives through related illnesses that are preventable and treatable,” Carper said. “I’m proud of our bipartisan and bicameral legislation to open the door for Medicare to provide Americans with every available treatment and tool for reducing obesity’s physical, social, and financial costs.”
