When the new administration announced in April that it would not be implementing expanded access to obesity medicines in Medicare, they suggested this would not be the final word. Yesterday, we got a hint of what might come. Paige Winfield Cunningham reported in the Washington Post that CMS has drafted a plan to allow Medicare Part D plans, as well as state Medicaid programs, to experiment with covering obesity medicines.

The proposal is an experiment that would be overseen by CMMI – the Center for Medicare and Medicaid Innovation.

Metabolic Health Innovation

Cunningham reports that CMS documents describe this experiment as an effort to improve metabolic health by covering GLP-1s and provide “a healthy lifestyle support system.” While it appears that this proposal has support within CMS, it is not final. HHS Secretary Robert F. Kennedy Jr. has sent mixed messages about obesity medicines. At one point he said pharma was selling them to Americans “because we’re so stupid and so addicted to drugs.” But more recently his words have been a bit more moderate:

“The first line of response should be lifestyle. It should be eating well, making sure you that you don’t get obese. Those GLP drugs have a place.”

Welcome News

This crack in the door for Medicare coverage of obesity medicines is welcome news. The Obesity Care Advocacy Network issued a statement applauding this and said:

“We hope CMS moves forward in this process and we look forward to providing feedback to ensure that all Americans can receive life-changing treatment.”

Indeed we do. This will be incremental progress, if it happens, that will put Medicare beneficiaries on equal footing with people on other drug plans. So, of course, they will still have to fight with their PBMs over coverage and co-pays.

Click here, here, and here for more on this development.

Moonlight, Strandgade 30, painting by Vilhelm Hammershøi / Metropolitan Museum of Art