Prepared by Christopher Gallagher, OCC Washington Representative
Finance Committee Chair Wyden Asks CBO to Score the Treat and Reduce Obesity Act
During September, Senate Finance Committee Chair Ron Wyden (D-OR) requested that the Congressional Budget Office (CBO) provide a fiscal score for the Treat and Reduce Obesity Act (TROA). Rumors on the Hill suggest that CBO will provide a high level cost number for TROA sometime in October or November. Meanwhile, support for the legislation has grown to 174 with 152 House cosponsors and 22 Senate cosponsors.
White House Conference on Hunger, Nutrition and Health
On September 27, the White House released its National Strategy Report in preparation for its historic Conference on Hunger Nutrition and Health on September 28. The National Strategy report addresses five pillars to advance the goal of the conference: 1) Improving food access and affordability; 2) Integrating nutrition and health; 3) Empowering all consumer to make and have access to healthy choices; 4) Supporting physical activity for all; and 5) Enhancing nutrition and food security research.
Of particular note is Pillar 2 on Integrating Nutrition and Health on pages 17-21 which highlights the need for “expanding Medicare beneficiaries’ access to nutrition and obesity counseling” and includes language that directly alludes to the Part B IBT for obesity portion of TROA and specifically to the idea that CMS may already have the authority to do this.
Expand Medicaid beneficiaries’ access to nutrition and obesity counseling. The Affordable Care Act (ACA) requires coverage of obesity counseling for certain patients enrolled in most private group health plans and group and individual health insurance and certain beneficiaries among the 20 million people covered under the ACA’s expansion of Medicaid. The Biden-Harris Administration supports expanding nutrition and obesity counseling coverage to millions more Medicaid beneficiaries that currently are not guaranteed access to these services, particularly in states that have not expanded coverage and which have large rural populations.
Expand Medicare beneficiaries’ access to nutrition and obesity counseling. Medicare currently covers medical nutrition therapy services, including nutritional assessments and counseling, but only for people with diabetes or kidney disease, when ordered by a physician and performed by a dietitian. Medicare also covers obesity screenings and behavioral counseling to help patients with obesity lose weight, but only for patients with obesity and when performed by primary care clinicians in an office setting. The Biden-Harris Administration supports efforts to expand evidence-based nutrition and obesity counseling benefits to Medicare beneficiaries with additional conditions and to allow appropriate providers to offer obesity screening and behavioral counseling to help patients lose weight. HHS CMS will also examine existing Medicare authorities on ways to increase access to nutrition and obesity counseling. Additionally, HHS CMS will use its provider education channels to increase awareness of Medicare coverage of nutrition and obesity counseling services.
CDC Calls for both Prevention and Treatment of Obesity
In late September, the Centers for Disease Control and Prevention (CDC) released its 2021 Adult Obesity Prevalence Maps — finding that nearly 42 percent of adults are now affected by obesity. In reporting these data, CDC highlights the importance of equitable access to prevention and treatment. CDC’s September 27th press release states that, “Supporting adults with obesity and its related health issues will take a sustained, comprehensive effort from all parts of society to reduce disparities and improve the health of our communities. In addition, obesity is a disease for which treatment options exist, including proven weight management programs, medications, and bariatric surgery. However, there is inequitable access to proven obesity treatment in the United States.”
Trust for America’s Health 2022 State of Obesity Report
TFAH’s report, which is based on CDC data, highlights that the national adult obesity rate is now 41.9 percent, the national youth obesity rate is 19.7 percent, and now 19 states now have adult obesity rates higher than 35 percent. On a positive note, TFAH does recommend that “Medicare expand coverage of weight management and obesity related services such as obesity and nutritional counseling provided by registered dietitians, anti-obesity medications and bariatric surgery. The report also does a pretty good job of using people first language and addressing bias and stigma.
Obesity Advocates Respond to ICER Final Evidence Report on AOMs
On September 16th, obesity advocates Joe Nadglowski, Nikki Massie and Drs. Lee Kaplan and Scott Kahan participated in a public meeting convened by the Institute for Clinical and Economic Review (ICER) following release of its final evidence report on the effectiveness and value of anti-obesity medications (AOMs).
The final ICER report found:
“In summary, among the agents we reviewed, greater weight loss was seen with semaglutide and with phentermine/topiramate; less weight loss was seen with liraglutide and with bupropion/naltrexone. Although few serious harms were noted for all the interventions, semaglutide may have lower rates of discontinuation and, along with liraglutide, may have additional cardiovascular benefits that extend beyond weight loss effects. Phentermine/topiramate is substantially less expensive than semaglutide and liraglutide, meets commonly accepted cost- effectiveness thresholds and is actually cost-saving when prescribed generically. Bupropion/naltrexone is cost effective only at higher thresholds, but is cost effective when prescribed generically. Semaglutide requires substantial discounts from the wholesale acquisition cost to meet typical thresholds, but it is more effective, less burdensome, and more cost effective than liraglutide.”
During the September 16th public hearing on the report, obesity advocates urged drug companies to implement patient assistance programs to make these drugs more affordable—especially in light of health equity issues. Also, health insurance companies must treat obesity as a chronic disease and employers need to demand coverage of obesity care in the plans they choose for their employees. Advocates also spoke about the need to address bias and stigma across all areas.
State Advocacy Progress
Medicaid Coverage of Obesity Drugs in PA
While obesity advocates in Pennsylvania continue to push for passage of Senate Bill 782 and House Bill 293, which are being championed by Senator Joe Pittman and Representative Donna Oberlander, respectively, OMA Advocacy Committee member Dr. Verlyn Warrington has made tremendous progress in securing Medicaid coverage through the state’s P&T Committee. Through Dr. Warrington’s work, the P&T Committee has decided to provide coverage beginning in 2023 and has invited Dr. Warrington to become a member of the P&T committee in 2023.
Ohio Obesity Advocates Score Big Win with State Medical Board AOM Rx Rules
On February 11, 2022, the State Medical Board of Ohio (SMBO) published new proposed rules (4731-11-04) for public comment, entitled “Controlled substances for the treatment of obesity.” Obesity Care Continuum groups supported Ohio obesity advocates in urging the SMBO to make changes to the proposed regulations to provide for greater access to AOMs. On September 22nd, the SMBO released the revised regulations, which incorporate many of the changes suggested by the obesity community, such as allowing FDA-approved AOMs for short-term use to be continued beyond three months provided the patient maintains a 5 percent weight reduction.