CMS decision on obesity medications leaves gap in health care access for millions of Americans

Rockville, Md. – The Obesity Society is disappointed with the decision made by the Centers for Medicare and Medicaid Services (CMS) to continue its policy that restricts access to safe and effective obesity medications. The announcement that CMS will reject Part D coverage of obesity medications and application to the Medicaid program in a final rule last week has both clinical and ethical implications for those living with the chronic disease and the providers who treat them. 

“While there are proven treatments including obesity medications, most Americans and those on Medicare, are not able to access interventions other than metabolic surgery which is highly effective, but also a more invasive approach,” stated The Obesity Society President Marc-Andre Cornier, MD, FTOS.  “Providers are left in a position where obesity treatment options that are known to be effective are not practical for many living with obesity because they are not able to afford to pay out-of-pocket costs for medications. Knowing there are options to treat a disease and not being able to prescribe them is disheartening for providers, we want to help people and of course for our patients who feel like the system is failing them.” 

When Medicare beneficiaries can’t afford obesity medications, they may go untreated or seek non-conventional and unproven treatments if metabolic surgery is not an option. The cost of the medications and marketing of non-FDA approved compounded treatments have led to many consumers purchasing the medications without medical care. Moreover, obesity in older adults is also associated with a higher risk of cardiovascular diseases, cardiometabolic disease (like diabetes), certain cancers, and other medical conditions further impacting one's health and driving healthcare costs. 

“The CMS final rule is a set-back, but it is also a call to action for not only those who champion obesity care, but for clinicians across medicine and the patients they serve,” stated Dr. Cornier.   

“We have focused on treating the conditions and diseases associated with obesity for too long, it is time to treat obesity first,” emphasized Dr. Cornier.  “One action now is for providers to ensure they diagnose obesity in the medical record.  More awareness by providers is one step in advocating for appropriate treatments to be available.” 

TOS also remains dedicated to advocating for the Treat and Reduce Obesity Act, legislation that would increase access to both obesity medications and intensive behavioral therapy for Medicare beneficiaries. In addition, TOS will engage in additional future regulatory opportunities regarding Medicare rules. 

TOS calls on the entire medical community to join efforts to advocate for comprehensive and accessible obesity care. “Given the rates of obesity, it is likely that every person is somehow impacted by obesity. We need everyone from researchers to clinicians to communities to do their part to combat overweight and obesity if we want to make America healthy.” 

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The Obesity Society (TOS) is the leading organization of scientists and health professionals devoted to understanding and reversing the epidemic of obesity and its adverse health, economic and societal effects. Combining the perspective of researchers, clinicians, policymakers and patients, TOS promotes innovative research, education and evidence-based clinical care to improve the health and well-being of all people with obesity. For more information, visit www.obesity.org.