Biden Administration Recognizes Obesity Drugs as Part of Covered Obesity Treatment in Proposed Rule
Today the Centers for Medicare and Medicaid Services (CMS) announced they are rethinking the way the federal and state health care programs cover obesity treatment—recognizing obesity as a chronic disease. The Administration proposes to cover Food and Drug Administration (FDA) approved medications to reduce excess weight that leads to health conditions for Medicare Part D, Medicare Advantage and Medicaid beneficiaries who have obesity. Until now, breakthrough obesity medications were only covered by Medicare for treatment of medically accepted conditions, like type 2 diabetes. Under the current proposal, coverage will be expanded to anyone with a Part D or Medicare Advantage plan or who is enrolled in the Medicaid program and has obesity, allowing beneficiaries to access therapies that can help prevent the onset of type 2 diabetes and other comorbidities like cardiovascular disease.
“This is a historic moment for people living with obesity in the United States, who stand to benefit a great deal from available obesity medications but have not been able to because of outdated Medicare rules,” said Chuck Henderson, CEO of the American Diabetes Association® (ADA). “This policy change has been a top priority for the ADA and I’m so proud of the work our team and our community has done together to make progress for Americans living with obesity. We are very pleased that the Biden administration has listened to seniors and Medicaid enrollees— recognizing obesity as the chronic disease it is and taking action to support access to treatments that can provide a better quality of life and health.”
The proposed rule announced this morning also expands access to behavioral health services, takes critical steps to make sure seniors enrolled in Medicare Advantage plans are not being denied coverage of the services and treatments they need, and creates guardrails to protect Medicare beneficiaries’ health data. The proposal, which must now go through a formal rulemaking process through CMS, is scheduled to go into effect in 2026. The ADA will continue to advocate for Medicare and Medicaid coverage of obesity treatment including medications throughout the upcoming public comment period and as CMS prepares to implement this historic policy change.
# # #
About the American Diabetes Association
The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to end diabetes and helping people thrive. For 84 years, the ADA has driven discovery and research to prevent, manage, treat, and ultimately cure diabetes. There are 136 million Americans living with diabetes or prediabetes. Through advocacy, program development, and education, we’re fighting for them all. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Spanish Facebook (Asociación Americana de la Diabetes), LinkedIn (American Diabetes Association), and Instagram (@AmDiabetesAssn).
