Latest news with #AOMs
CBS News
04-04-2025
- Health
- CBS News
Medicare and Medicaid will not cover weight loss drugs, Trump administration decides
The Trump administration has decided against implementing a proposal for Medicare and Medicaid to cover weight loss drugs , the Centers for Medicare and Medicaid Services said in a filing published Friday by the agency. A CMS spokesperson said the agency now believes that finalizing the proposal "is not appropriate at this time." "CMS may consider future policy options for AOMs pending further review of both the potential benefits of these drugs including updated clinical indications, and relevant costs including fiscal impacts on stakeholders such as state Medicaid agencies," Catherine Howden, the spokesperson, said in an email. Medicare already covers drugs that are also widely used for weight loss, like Ozempic and Mounjaro, when they are prescribed by doctors for other reasons like managing diabetes. But under the statute governing Medicare and Medicaid, the federal government is generally banned from covering drugs "when used for weight loss." Under the Biden administration, CMS had proposed to reinterpret this statute, bypassing the Congressional ban on coverage of weight loss drugs for obese, but not overweight, patients. Since obesity is now widely agreed to be a disease, the Biden administration had said, treatment of that disease should be covered by Medicare's Part D prescription drug benefit. They pointed to other situations when these kinds of drugs are allowed to be covered, like when weight change is caused by AIDS. Expanding coverage of anti-obesity medications this way would also affect state Medicaid plans, officials said, since they are governed by the same law. "CMS' revised interpretation would recognize obesity to be a chronic disease based on changes in medical consensus," the agency had said last year . The proposal was expected to be costly for the federal government. The Congressional Budget Office had previously estimated that expanding Medicare coverage to anti-obesity medications could add up to $35 billion over the next decade, even after factoring in expected savings from improved health of beneficiaries. Medicaid programs would also have shouldered billions more in costs to cover the medications, Biden administration officials acknowledged, split between the federal government and states. "States are also feeling substantial state budget pressure and we are doing our part to make sure patients, Medicaid enrollees all across the country can get access," Dan Tsai, the agency's top Medicaid official under the Biden administration, had told reporters. Top advisers to Health and Human Services Secretary Robert F. Kennedy Jr., who now oversees CMS, among the nation's federal health agencies, had criticized the Biden-era move. Healthcare entrepreneur Calley Means, now a special government employee under Kennedy, had called it a "betrayal of any American who cares about" the Make America Healthy Again movement's principles. "Americans did NOT vote for mass injections in this election. They voted for a shift to ROOT CAUSE interventions and benefit flexibility," Means said in a post on X at the time.
Miami Herald
07-03-2025
- Health
- Miami Herald
Miami lawmaker pushes for Medicaid, Medicare to cover anti-obesity medicine
For a state of over 23 million people, approximately 40% of the population has one thing in common — they are either Medicare or Medicaid beneficiaries. Across the Sunshine State, just shy of nine million people utilize government health insurance programs. With many individuals in Florida relying on these programs, ensuring they are as comprehensive as possible is key to improving health. For many beneficiaries of these programs, one of the biggest health issues they face is obesity and its various co-morbidities. But just 10% of people with obesity receive any treatment for the disease. In the Florida Legislature, which went into session this week, we're looking to change that. I've introduced legislation, Senate Bill 648, that would expand Medicaid treatment options for obesity, including covering the cost of the use of Food and Drug Administration (FDA) approved anti-obesity medications, known as AOMs. Now, I hope the federal government follows our lead. President Donald Trump has long fought for commonsense healthcare reform. Fortunately, he has a chance to deliver on it. He is reviewing a rule from the Centers for Medicare & Medicaid Services (CMS) which establishes or modifies what Medicare and Medicaid will cover. Only by finalizing this proposed CMS rule and expanding AOM can their full potential be realized in Florida and across the country. It's necessary that Trump finalize it. Obesity is the nation's second leading cause of death and raises an individual's mortality rate from anywhere from 22% to 91%. Not to mention, it's a significant risk factor for the leading cause of death: heart disease. Beyond that, it's connected to over 200 other serious chronic diseases ranging from diabetes to 13 of the most prevalent cancers to arthritis. All told, the impact of obesity on the human body is severe. For years, lifestyle changes, primarily diet and exercise, have been the primary treatment option for obesity. But it's clear that this alone is not the most effective treatment available. For patients who adopt lifestyle changes and nothing else, more than 95% of weight lost is regained within five years. That's where AOMs come into play. AOMs have been proven to be a highly effective tool in treating obesity. Over the last several years, a sizable body of research has shown their benefits, including reduced blood pressure, reduced sleep apnea, improved glycemic health and significant, sustained weight loss. They provide a pathway to weight loss that, in turn, reduces the risk of obesity-related complications. For our state's seniors, reducing obesity can mean a lessened risk of falls, better mental health and a lower chance of nursing home admission, all of which serve to enhance independence. But right now, far too few individuals have access to them. Of the 10% of people who receive any medical help for obesity, a minuscule 2% subset take AOMs. Annually, across the entire U.S. public and private healthcare system, hundreds of billions of dollars are spent on obesity and related illnesses. Looking at the Medicare and Medicaid programs alone, that figure is beginning to encroach on $100 billion a year. The link between obesity and other chronic diseases is clear and lead down the same path — more hospitalizations, more deaths and higher annual medical costs. On the flip side, the broader use of AOMs, particularly among Medicare and Medicaid recipients, has a clear line to fewer medical costs in treating obesity and related conditions. The more effective treatment of obesity through Medicare and Medicaid could lead to net savings of over $700 billion over the next 30 years. Obesity is one of our nation's biggest public health crises, and AOMs are a pivotal innovation in the healthcare space as we look to solve it. Only by finalizing this proposed CMS rule and expanding AOM coverage in Medicare and Medicaid can their full potential be realized. Ana Maria Rodriguez is a Republican state senator representing District 40, which includes parts of southern Miami-Dade and Monroe counties.
