Proposed Ruling by the Center for Medicare and Medicaid Services
On November 26, 2024, the Center for Medicare and Medicaid Services (CMS) proposed a new rule that would provide coverage for obesity medications. On January 16, AMWA lead a briefing to raise awareness of this new rule and the opportunity for public comment before January 27.
AMWA submitted the following statement:
The American Medical Women’s Association (AMWA) wholeheartedly supports the Centers for Medicare & Medicaid Services (CMS) proposed rule to provide coverage for obesity medication. This policy aligns with the current medical consensus recognizing obesity as a chronic disease.
Obesity represents a significant epidemic in the United States, and we urge the administration to advance and finalize this policy. By expanding access to obesity medications, the proposed CMS rule addresses a critical health crisis affecting our nation. A decade ago, no state reported an obesity prevalence above 35%. Today, over 22 states report a prevalence of 35% or higher.
From a women’s health perspective, this issue is particularly concerning. Obesity is a risk factor for heart disease, the leading cause of death among women. It also exacerbates other heart disease risk factors. Obesity prevalence is higher in women (41.3%) compared to men (39.2%), and severe obesity is twice as prevalent in women than in men across all age groups.
The exclusion of “weight loss” medications under Medicare Part D has been a significant barrier for older Americans seeking access to safe and effective FDA-approved pharmacotherapy for obesity treatment. We are grateful that this proposed ruling aims to rectify Medicare’s outdated exclusion of weight loss medications, allowing for the treatment of obesity as a chronic disease similar to other chronic conditions.
Obesity is a manageable chronic disease that significantly contributes to various other health conditions, including type 2 diabetes, hypertension, heart disease, fatty liver disease, kidney disease, lipid disorders, certain cancers, sleep apnea, arthritis, and mental illness. Effective treatment of obesity requires a comprehensive approach, including intensive behavioral therapy (IBT), lifestyle modifications, pharmacotherapy, and bariatric surgery. This new proposed Medicare rule will help facilitate such comprehensive treatment.
Lancet Commission
This month, the The Lancet Diabetes & Endocrinology published a global Commission on the definition and diagnostic criteria of clinical obesity. AMWA was one of the U.S. based organizations which endorsed the recommendations, along with the American Diabetes Association and the American Heart Association.
Key takeaway points for the Lancet Commission were to propose a new definition and diagnostic framework for how we approach obesity.
The new definition separates “preclinical obesity,” defined as “a condition of excess adiposity without current organ dysfunction or limitations in daily activities but with increased future health risk” from “clinical obesity,” defined as “a chronic, systemic disease state directly caused by excess adiposity.”
The report also highlights the limitations of BMI and identifies other measurements of body size (waist circumference, waist-to-hip ratio, or waist-to-height ratio), in addition to BMI, to define obesity status.
AMWA is grateful for the leadership of Dr. Fatima Cody Stanford in her role within the Lancet Commission and our opportunity to endorse these recommendations.