Members of the House have brought back efforts to pass the Treat and Reduce Obesity Act bill.
The bill would have a direct effect only on Medicare Part D prescription drug plans: It would let the plans cover weight-loss drugs for obese people and for overweight people with weight-related health problems.
The drug coverage provision does not mention any specific drug by name, but it could include the GLP-1 agonists, such as Wegovy; drugs that combine GLP-1 agonists with GIP agonists, such as tirzepatide, the active ingredient in Mounjaro; and other types of drugs, including the kind of topiramate-phentermine combination that powers Qsymia.
A second provision would let Medicare cover intensive behavioral therapy for obesity furnished by a wide range of providers. Today, Medicare can cover anti-obesity therapy only if it’s furnished by primary care providers.
A third provision would encourage all federal agencies to do what they can to support research programs related to efforts to treat, reduce and prevent obesity.
What it means: If Medicare drug plans expanded coverage for anti-obesity drugs, that could support employer plan efforts to maintain or expand anti-obesity drug coverage.
Any successful new federal anti-obesity research programs could also affect employer plans, by reducing employer plans’ spending on obesity-related health problems.
The backers: Rep. Mike Kelly, R-Pa., has introduced the new House version of the bill late last month. The House version has five Republican co-sponsors and 11 Democratic co-sponsors.
Sen. Bill Cassidy, R-La. — a physician who serves as chair of the Senate Health, Education, Labor and Pensions Committee — has introduced the Senate version of the bill.
Cassidy has lined up 12 Democratic co-sponsors and six Republican co-sponsors for the Senate version.
Millicent Gorham, chief executive officer of the Alliance for Women’s Health & Prevention, put out a statement welcoming the reintroduction of the bill.
The history: Lawmakers have been introducing versions of the Treat and Reduce Obesity Act bill since 2011.
The House Ways and Means Committee voted to support a version of the bill in 2024.
The numbers: Employer plans have wrestled with decisions about whether to cover expensive new weight-loss drugs based on ingredients such as phentermine, semaglutide and tirzepatide.
David Joyner, who was the president of CVS Health’s Caremark pharmacy benefit manager unit and who is now the CEO of CVS Health, said at a House Oversight Committee hearing in July 2024 that covering weight-loss drugs like Wegovy at 2024 prices for all obese people and overweight people with health problems might cost the United States about $1.2 trillion per year.
CBIZ has estimated that use of GLP-1 agonists like Wegovy to control both obesity and diabetes accounted for about 17% of employers’ pharmacy benefits spending in 2024.
But obesity itself has been a big burden on U.S. employers.
Analysts at the Milken Institute estimated that obesity costs the U.S. economy as a whole $1.4 trillion per year, meaning that the direct and indirect economic impact of obesity amounts to 6% of U.S. gross domestic product.
Academic researchers estimated that the direct and indirect impact of obesity and overweight on U.S. employers in 2023 was $425 billion.