Disclosures

Letter to Dr. Oz for expansion of obesity medications in Medicare and Medicaid 12.9.25.pdf

OCAN Letter to CMS Administrator Mehmet Oz on Expanding Medicare Obesity Care Coverage

As the obesity treatment advocacy community continues to push for greater coverage for older Americans, the administration has delivered another critical victory: a landmark Medicare and Medicaid price negotiation deal for GLP-1 medications like Wegovy and Zepbound. This crucial agreement to lower the cost of these highly effective treatments is a powerful, long-overdue acknowledgment that obesity is a chronic disease requiring comprehensive, affordable treatment. The negotiation and expansion to Medicare and Medicaid represent meaningful progress, but policymakers must ensure these actions become the foundation for broader, permanent access. To fully secure this progress and deliver comprehensive, evidence-based care for all Americans living with obesity, Congress must codify this policy into law by passing the Treat and Reduce Obesity Act (TROA).For patients like Barbara, my colleague and fellow patient advocate, who has battled obesity for over five decades, this policy shift represents a profound new opportunity. She had exhausted every program available through her employer's plans, finding only temporary relief. When her doctor recommended a GLP-1, she was linked to a new virtual obesity clinic and its comprehensive care team. This team prioritized a deep understanding of her health history, challenges, and personal goals, enabling them to deliver truly evidence-based and personalized care.This holistic approach led to sustainable, life-altering success. Barbara achieved a remarkable 37 percent body weight loss, alongside significant health improvements: lowered blood pressure and cholesterol, and stable blood glucose levels. These physical changes ignited improvements in her mental health, mobility, and productivity. She now runs a thriving business and has renewed energy for her grandkids. Crucially, the comprehensive care model gave her the support, confidence, and tools to maintain her progress and eliminate the constant anxiety of weight recurrence, which past programs could not achieve.Barbara’s results may be optimal, but the journey is not. More than&nbsp;<a href="https://www.cdc.gov/nchs/products/databriefs/db508.htm">2 in 5</a>&nbsp;American adults live with obesity, a chronic, complex disease that is far too often misunderstood and undertreated. Yet up until this promising agreement, Medicare has not covered the full range of evidence-based treatments. The statutory exclusion preventing Medicare Part D from covering these highly effective GLP-1-based medications remains a major roadblock, leaving millions of older Americans without access to the care they need.Significant health improvements can be achieved by investing in comprehensive, expert-led obesity treatment programs. The combination of medical evaluations, nutritional counseling, physical activity, intensive behavioral therapy, judicious medication prescribing, surgery when appropriate, and long-term support can lead to substantial savings. While comprehensive coverage is the goal, the federal government must take the ultimate meaningful step by adopting TROA to permanently lift the exclusion and ensure that the positive momentum from the recent price negation announced by the White House is not a temporary policy.For policymakers still needing to be convinced, several programs and organizations have already demonstrated the effectiveness and cost-savings of comprehensive obesity care. These models highlight that when treatment is integrated, coordinated, personalized, and focused on adherence, the results are significant for both patients and payers.One real-world model is the State of Connecticut’s Comprehensive Obesity Care (COC) program, a pilot with FlyteHealth, that treats approximately 300,000 state employees and retirees. Unlike single-disease or medication-only programs, the COC program delivers lasting outcomes with high adherence, measurable improvements across weight and cardiometabolic markers, and proven reductions in total cost of care.The results are clear. An independent analysis by Milliman found the Connecticut COC program achieved an&nbsp;<a href="https://www.prnewswire.com/news-releases/flytehealth-obesity-care-program-demonstrates-cost-avoidance-and-noteworthy-medication-adherence-in-year-one-outcomes-302466456.html">86 percent adherence</a>&nbsp;rate among new GLP-1 users and avoided up to&nbsp;<a href="https://www.prnewswire.com/news-releases/flytehealth-obesity-care-program-demonstrates-cost-avoidance-and-noteworthy-medication-adherence-in-year-one-outcomes-302466456.html">$3.6 million</a>&nbsp;in annual costs by improving patients’ overall cardiometabolic health, leading to reductions in blood pressure, glucose levels, and other key health metrics. After six months, the State of Connecticut expanded and extended the program through a multi-year agreement.Other states and organizations are also charting promising paths forward. In Delaware, the&nbsp;<a href="https://insurance.delaware.gov/wp-content/uploads/sites/15/2025/09/GLP-Trends-Report-2025.pdf">State Employee Benefits Committee</a>&nbsp;approved coverage for FDA-approved obesity medications in March 2023. Employees must meet specific criteria to be eligible, such as having a diagnosis of obesity, completing a diet and exercise trial, and demonstrating a clinical response.Wilmington, DE’s self-funded program covers roughly 3,000 employees, retirees, and their families. City-incorporated federal initiatives like the National Diabetes Prevention Program (NDPP) and “We Go HARD for Health” have produced&nbsp;<a href="https://coveragetoolkit.org/wp-content/uploads/2021/10/City-of-Wilmington-Case-Study-Final.pdf">tangible results</a>: among 61 participants, an average 5 percent weight loss is projected to generate approximately $151,000 in savings. These programs illustrate how targeted, localized interventions can achieve measurable health improvements while managing costs.When payers, employers, and government programs prioritize evidence-based obesity care, all Americans benefit.Barbara’s story shows the power of evidence-based treatment paired with the right support.&nbsp; The landmark price negotiation deal for GLP-1s recently announced by the White House demonstrates strong administrative will. Now, Congress must act. Policymakers have an opportunity to move beyond short-sighted budget concerns and embrace a permanent solution by passing TROA to improve health outcomes while simultaneously curbing long-term spending. Giving older adults guaranteed access to proven obesity treatments is not only the standard of care, but it's also a critical investment in their health and the financial sustainability of the healthcare system.Christine Gallagher is the Coordinator of the Obesity Care Advocacy Network (OCAN) and the Associate Director for Research and Policy of the STOP Obesity Alliance at the Milken Institute School of Public Health at George Washington University.

Codify the Cure: Why Congress Must Still Pass the ‘Treat and Reduce Obesity Act’

Washington, D.C. - The Obesity Care Advocacy Network (OCAN) applauds the Trump administration for taking historic and decisive steps to make life-changing obesity medications more accessible and affordable for millions of Americans.The announced agreements will enable Medicare and Medicaid to cover obesity medications at significantly lower costs, marking the first time such coverage will be available for older adults with obesity.These are transformative steps that will make a real difference for millions of Americans living with obesity, lowering barriers to comprehensive care and representing a historic opportunity to reverse the obesity epidemic when coupled with intensive behavioral therapy (IBT) and metabolic and bariatric surgery.We would also like to recognize the tireless work of the entire obesity advocacy community. It is their persistent efforts that have helped to achieve this policy milestone and ensure that policymakers are fully aware of the significance of providing access to these critical, evidence-based obesity medications.But this progress must not stop here. Congress should build on this momentum by passing the Treat and Reduce Obesity Act (TROA)—legislation that would ensure Medicare access to the full range of obesity care, including expansion of the intensive behavioral therapy benefit.&nbsp;OCAN remains committed to advancing comprehensive, evidence-based solutions that improve obesity care so that every American has the opportunity to achieve better health and quality of life.

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