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Advocacy blitz targets Medicare coverage of obesity treatment

The push by stakeholders centers on securing regulatory changes or including a long-standing bill in must-pass legislation

A man with Type 1 diabetes tests his blood glucose level before injecting insulin. Obesity is a risk factor for diabetes and several other chronic conditions, including heart disease and stroke.
A man with Type 1 diabetes tests his blood glucose level before injecting insulin. Obesity is a risk factor for diabetes and several other chronic conditions, including heart disease and stroke. (Paul Chinn/San Francisco Chronicle via Getty Images file photo)

A coalition of patient advocates, medical groups and pharmaceutical companies is ramping up pressure on Congress to add coverage of obesity drugs and weight-related behavioral therapy under Medicare.

The push centers on securing regulatory changes or including a long-standing bill in must-pass legislation. The bill would remove Medicare’s ban on coverage of weight loss drugs and expand behavioral therapy coverage. 

Advocates say the drug carveout stems from lingering cultural stigma around obesity and a societal view that weight problems are a personal failure. Obesity was recognized as a disease by the American Medical Association in 2013, and the incidence of obesity has grown over time. The bipartisan bill, sponsored by Ron Kind, D-Wis., in the House and Thomas R. Carper, D-Del., in the Senate, has 117 co-sponsors between the two chambers.

About 42 percent of U.S. adults were considered obese in 2018, according to the Centers for Disease Control and Prevention. Obesity is a risk factor for many other top chronic diseases, including diabetes, heart disease and stroke. Annual obesity-related medical costs are estimated at $147 billion to $210 billion.  

In addition to improving patient health, advocates say, expanding Medicare coverage could save money if treatment prevents more complications later. But it’s not clear how the Congressional Budget Office will score the legislation, and lawmakers are feuding over whether to expand Medicare in other ways amid cost concerns. 

Medicare covers behavioral therapy through a patient’s primary care provider but excludes other providers such as dietitians and psychologists. 

Primary care providers often lack the time and training needed for intensive therapy, said Johns Hopkins University associate professor Kimberly Gudzune, medical director of the American Board of Obesity Medicine. Studies show providers with psychology and dietitian backgrounds can be more effective.

“Sometimes you actually get better outcomes than when you use a physician,” she said.

Drug industry ties

The drug industry is also deeply invested in the obesity field, and it stands to gain access to the $102 billion Part D drug market if the Medicare ban is lifted. Insulin and weight loss drug manufacturers like Novo Nordisk and Eli Lilly donate cash to many advocacy groups, politicians and medical research projects associated with obesity treatments, including Kind and Carper. Kind’s office did not respond to requests for comment. 

“Senator Carper’s Treat and Reduce Obesity Act has a robust group of bipartisan cosponsors and widespread support from groups representing American families struggling with obesity,” a spokesman for Carper said. “Unleashing federal Medicare dollars for treatments against obesity would help millions of Americans lead longer and healthier lives.”

In June, a consortium of industry and medical groups making up the Obesity Care Advocacy Network, or OCAN, launched the Obesity Care Now campaign. The group churned out news releases, sponsored newsletters and participated in webinars featuring lawmakers recently. High-profile groups like the NAACP and the National Urban League endorsed the campaign.

Novo Nordisk is the top industry donor to OCAN’s parent organization, the Obesity Action Coalition, and pays for progressive messaging firm Precision Strategies to help carry out the campaign.

Joe Nadglowski, who is OCAN’s co-chair as well as president and CEO of the Obesity Action Coalition, told CQ Roll Call the campaign’s content is decided by consensus among OCAN’s members and Novo Nordisk’s donations don’t impact the group’s policy decisions. Industry donations make up around 20 percent of the coalition’s more than $7 million budget, he said.  

The rest comes from fees from their 75,000-plus members, events and donated in-kind services. Other drugmakers, medical groups and weight loss companies also donate money. 

“We very much continue to struggle with having obesity recognized as a disease by policymakers, health care professionals and others, and many of the organizations involved in OCAN have been advocating around this issue for more than a decade,” Nadglowski said. “It’s going to take a concerted effort, composed of multiple stakeholders, to increase access to care for people with obesity.”

Representatives for Precision Strategies and Novo Nordisk declined to disclose Precision’s budget or when Novo hired the firm.

“Unfortunately, outdated Medicare rules deny access to the full continuum of care for patients,” Novo spokesperson Michael Bachner said in a statement. “Novo Nordisk has supported the expansion of Medicare for almost a decade, including support for the Treat and Reduce Obesity Act since its introduction in 2013. Novo Nordisk joined the Obesity Care Advocacy Network in 2015.”

The group wants Congress to tuck its priorities into legislation such as Democrats’ House-passed $2 trillion budget reconciliation bill in the Senate. Even if they don’t succeed, Nadglowski said signs point to it becoming an increasingly higher priority for lawmakers.

“We’re prepared to move on to the next bill, if that’s what it takes,” he said.

OCAN is also encouraging the Centers for Medicare and Medicaid Services to broaden coverage through regulatory means, but there are questions about whether it has the authority. CMS did not respond to an inquiry.

New wave of drugs on horizon

The push comes on the cusp of a potential wave of new obesity drugs, and the campaign launch coincided with the June approval of Novo’s blockbuster obesity treatment Wegovy, a synthetic gut hormone that helps suppress appetite and has been shown to decrease weight by nearly 15 percent. That’s more effective than existing weight loss drugs, which typically show an average 3 to 7 percent weight loss.

“That gets us closer and closer to achieving weight loss similar to what we achieve with surgery,” said Gudzune, who works on a non-drug-related research grant from Novo Nordisk through Johns Hopkins and does drug-related consulting for Eli Lilly.

Gudzune says a “multistep” approach is needed for patients who don’t respond to lifestyle changes alone. Results from Wegovy and other drug candidates are an improvement over past products, she said.

The approval was the first for a weight loss drug since 2014. The other drug from Eli Lilly, tirzepatide, is generating even more buzz after promising clinical trial results were released in June. (While Eli Lilly is a member and donor to the coalition, a spokesperson said the company is not involved in the campaign.) More drugs, from Amgen, Boehringer Ingelheim and Pfizer, are also in the pipeline.

Nadglowski calls the timing a coincidence, although he acknowledged there was likely some “self-interest” on the part of Novo. The campaign was instead motivated by a lack of action on the bill, he said, and the heightened focus on the risk of obesity and racial disparities during the COVID-19 pandemic. 

“Obesity medications used to be like the realm of these small, venture capital-based companies that were searching for a blockbuster, right, but now you actually see the larger players in pharmaceuticals actually starting to invest money,” he said. “So we’re excited about that from that perspective, because I think one thing that doesn’t get talked about a lot is the reality is that most of us — myself included, as a person who struggles with obesity — haven’t found the right treatment.”

The Medicare market represents a major opportunity for manufacturers. Medicare’s prescription drug benefit reached 47 million enrollees and totaled $102.3 billion in spending in 2020. Nadglowski also said he expects private insurers to follow Medicare’s example if Congress broadens coverage.  

Initial sales of Wegovy — priced around $1,300 for a one-month supply — beat expectations. Novo Nordisk reported the drug helped drive a 15 percent growth in sales in the third quarter compared with the same period in 2020. Still, Medicare’s prohibition hampers the drug’s sales potential. Novo Nordisk Executive Vice President Doug Langa told investors on a November earnings call that the ban keeps Wegovy from reaching a “significant portion of the population.”

“We’re working really hard, and we hope to, at some point, whether it’s through the Treat and Reduce Obesity Act or some … other policy change, to open up that because, as a company, we certainly think that seniors in the U.S. should have access to anti-obesity medications,” he said.

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