Senators Cassidy and Carper urge CMS to update restrictive coverage policies on obesity drugs and IBT

U.S. Senators Bill Cassidy (R-La.) and Thomas Carper (D-Del.) are calling on the Centers for Medicare & Medicaid Services (CMS) to lift regulations that deny insurance coverage for obesity drugs and that limit coverage of Intensive Behavioral Therapy (IBT) amid the COVID-19 pandemic.

In a letter sent to CMS Administrator Seema Verma in early July, the senators request the agency use its administrative authority to update a nearly two-decade-old statute in the Medicare Part D prescription drug program that specifically excludes obesity drugs from Medicare coverage.

Sens. Cassidy and Carper call obesity the "second greatest risk factor, after old age, for hospitalization among COVID-19 patients." They cite data from New York City showing people with COVID-19 and obesity are twice as likely to be admitted to the hospital and those with severe obesity are 3.6 times more likely to require critical care such as mechanical ventilation.

The senators urge CMS to use its administrative authority to update its outdated and restrictive coverage policies surrounding FDA-approved obesity treatments and IBT, which they view as "critical to our response to COVID-19 and future public health emergencies."

The senators are the primary sponsors of the Treat and Reduce Obesity Act (TROA), which would allow CMS to expand Medicare Part D coverage to include FDA-approved prescription drugs for obesity and expand the IBT benefit by allowing additional types of qualified healthcare providers to offer these services. More than 185 members of Congress from both sides of the aisle are currently on record supporting TROA, but the bill has yet to come up for a floor vote since it was first introduced in 2013.

It's time for coverage policies and practices to catch up to the scientific evidence when it comes to treating obesity. We are newly dealing with the COVID-19 pandemic, but we've been dealing with the obesity epidemic for decades, and the time has come to employ treatment strategies across the entire continuum of care from behavioral therapy to drug treatment to bariatric and metabolic surgery. We encourage CMS to update its policies and for Congress to pass TROA."

Matthew M. Hutter, MD, MPH, President of the ASMBS and Professor of Surgery at Harvard Medical School

Metabolic/bariatric surgery has been shown to be the most effective and long-lasting treatment for severe obesity. Its safety profile is comparable to some of the safest and most commonly performed surgeries in the U.S. including gallbladder surgery, appendectomy and knee replacement. An estimated 252,000 bariatric surgeries were performed in the United States in 2018, which is approximately less than 1 percent of the population eligible for surgery.

The U.S. Centers for Disease Control and Prevention (CDC) reports 42.4 percent of Americans had obesity in 2017-2018. Obesity has been linked to more than 40 diseases including type 2 diabetes, hypertension, heart disease, stroke, sleep apnea, osteoarthritis and at least 13 different types of cancer.