Treating Obesity Shows the True Value of ‘Value Medicine’

Story By Scott Hall, Global Innovation Policy Center, U.S. Chamber of Commerce

It’s easy to measure a medicine’s impact in terms of patients served and lives saved. And yet, the impact of innovation extends far beyond individuals. Breakthroughs in life science also have the potential to help businesses grow the economy, address health disparities, and more. We call this phenomenon “value medicine,” and there are dozens, even hundreds of examples of diagnostics, vaccines, treatments, and cures that prove its power.

One such example: anti-obesity medications. In the United States, nearly 40% of adults have obesity, a diagnosis that reflects a complex disease. People with obesity can face difficult physical and psychological symptoms, but they can also face significant health costs as well as other financial and social burdens, including:

• Health costs and disease burden: Compared to people without obesity, people with obesity are at higher risk for many serious health conditions, including type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, and certain types of cancer. Further, people with obesity have a 6- to 12-fold increase in mortality rate.
• Financial costs: Obesity and obesity-related diseases account for approximately $480 billion in direct healthcare costs and $1.24 trillion in indirect work loss costs in the U.S.
• Quality of life costs: People with obesity report higher levels of pain and fatigue, lower self-esteem, as well as more negative feelings about themselves and their relationships. They report lower levels of enjoyment, satisfaction, energy, and restful sleep.
• Equity costs: Black and Hispanic populations are disproportionately affected by obesity.

Recognizing these realities, researchers and scientists in the life sciences have focused on developing a better understanding of the causes of obesity and potential solutions for patients in need. They’ve developed innovations that address the biological foundations of obesity, introducing medications that change the way the body absorbs fat, correct hormonal imbalances, and more.

Already, these medications have helped millions of people with obesity. But unfortunately, these medications’ full potential is yet unrealized. That’s because, right now, anti-obesity medications aren’t covered by Medicare, meaning many Americans can’t afford them. As a result, many Americans are missing out on better health outcomes, while Medicare is missing out on upwards of $12.3 billion in estimated savings over ten years.

Congress or the Centers for Medicare and Medicaid Services (CMS) can correct this problem. For example, the bipartisan Treat and Reduce Obesity Act (TROA) aims to grant coverage to FDA-approved anti-obesity medications under Part D, effectively bridging the gap in the continuum of care for people with obesity. CMS can also make this change via regulation by clarifying that anti-obesity medicines are not prohibited from coverage. After all, if a medication is proven safe and effective, shouldn’t it be made accessible to as many people as possible?

Leaders on both sides of the aisle agree that the answer is “yes.” That’s because anti-obesity medications have the power to save lives, save money, and advance a healthier society – but not if they’re left sitting on the shelf. Congress and CMS should support value medicine like anti-obesity medications for Medicare beneficiaries. It shouldn’t be a hard pill to swallow.