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Medicare should pay for medications for obesity

Obesity is a serious disease that has a major impact on the well-being of patients. People with obesity are more prone to other harmful conditions such as heart disease, stroke and type 2 diabetes.

Obesity also disproportionately affects specific populations over others. Non-Hispanic black adults had the highest age-adjusted obesity prevalence at 49.9%, followed by Hispanic adults at 45.6%, according to the Centers for Disease Control and Prevention. On the other hand, non-Hispanic Asian adults had a prevalence of 16.1%, while non-Hispanic white adults had a prevalence of 41.4%.

In general, men and women with college degrees are less likely to be diagnosed with obesity. Compared to the expense of a normal weight person, the medical expenses of a person diagnosed with obesity were $ 1,429 more per year.

A combination of individual and social factors play an important role in the development of obesity. These factors may include access to healthy eating; safe, comfortable and affordable places to exercise; personal stressors and medication use. Medicare helps address obesity through some treatment options for patients. However, some gaps make it difficult for certain patient populations to achieve optimal care.

Medicare currently covers bariatric surgery in cases of severe obesity with a BMI above 35. In addition, Medicare also launched an Intensive Behavioral Therapy initiative for Obesity in which patients with a BMI above 30 can Receive Free Obesity Exams and Behavioral Counseling to Promote Long-Term Weight Loss Changes. Some Medicare Part C programs may also include gym memberships and subscriptions to healthy home meal delivery programs.

Despite these benefits, an area of ​​coverage not provided by Medicare includes obesity pharmacotherapy. The FDA has five drugs approved for long-term use to treat obesity, including orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), and semaglutide (Wegovy).

One study has conducted an analysis to project budget savings of $ 20 billion to $ 23 billion for Medicare over 10 years following the expansion of pharmacotherapy coverage and intensive behavioral therapy. Failure to cover obesity medications can limit treatment options for beneficiaries and aggravate outcomes for low-income patients who cannot afford to seek complementary therapies such as uninsured obesity medications.

Medicare’s reluctance to approve anti-obesity medications includes safety issues with weight loss medications in the past. In 1997, drugs such as fenfluramine were found to damage the heart valves. The lack of long-term safety data is another reason why the U.S. Preventive Services Working Group does not recommend prescription drugs for weight loss.

However, studies have been done that predict the benefit of the expansion of anti-obesity medication at the individual level. For example, a retrospective study analyzed a representative sample of 2,735 adults from the National Health Surveys and Examinations from 2008 to 2016. Performed a 10-year simulation to predict the progression of a person’s health status as a function of of their individual profiles.

The model found that anti-obesity medications, when combined with lifestyle interventions, can help patients lose 9.7% of their excess weight and lead to lower costs in the ER, the outpatient care and hospital stays, resulting in a net saving of approximately $ 7,000 over 10 years. per person.

Given the potential of obesity medication for significant help in reducing weight loss, it is worth deliberating on the expansion of Medicare for this group of prescriptions to reduce health care costs, improve patient well-being and reduce the burden of chronic obesity-related conditions.

Medicare coverage of obesity medications will not only allow people to live healthier lifestyles and promote well-being, but will also reduce excessive costs in our already over-inflated healthcare system.

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