OCAN Letter to CMS Administrator Dr. Mehmet Oz

Administrator Mehmet Oz 

Centers for Medicare and Medicaid Services 

U.S. Department of Health and Human Services 

200 Independence Avenue, S.W. Washington, DC 20201 

Delivered Electronically to: Stephanie Carlton: stephanie.carlton@cms.hhs.gov

Regarding: Request for meeting regarding Medicare and Medicaid coverage of obesity medications and Medicare Part B Intensive Behavioral Therapy National Coverage Determination 

Dear Dr. Oz, 

On behalf of Obesity Care Action Network, we are requesting a meeting with you to discuss two important topics: the coverage of obesity medications in the Medicare and Medicaid programs and reopening the national coverage determination for intensive behavioral therapy under Medicare Part B. 

Founded in 2015, The Obesity Care Advocacy Network (OCAN) is a diverse group of organizations focused on changing how we perceive and approach obesity in the United States. OCAN works to increase access to evidence-based obesity treatments by uniting key stakeholders and the broader obesity community around significant education, policy and legislative efforts. We aim to fundamentally change how the U.S. healthcare system treats obesity, and to shift the cultural mindset on obesity so that policymakers and the public address obesity as a serious chronic disease. 

We appreciate the Centers for Medicare and Medicaid Services (CMS) acknowledgement that obesity is a chronic, complex, and treatable disease. While CMS noted the exclusion of obesity medications from the recent CY25 Medicare Advantage and Part D rule, we understand the agency is looking at a regulatory framework. We are pleased that CMS recognizes the broad national support for improving coverage for obesity medications in the Medicare and Medicaid programs as demonstrated by the strong number of public comments. Currently, regulatory prohibition excludes 40 percent of Americans aged 60 and older living with obesity from having the opportunity to get the evidence-based treatment they want, need, and deserve. Additionally, over 38 percent of individuals enrolled in Medicaid live with obesity and many states have made the commitment to provide access to obesity medications. We believe removing this prohibition for Medicare would be a very positive step toward making Americans healthy. 

Treating obesity with evidence-based, FDA-approved medications is a commonsense approach. Nearly a third of older Americans suffer from the disease of obesity. We would like to meet with you to discuss the next steps on ways to expand coverage of obesity medications by Medicare Part D and Medicaid enrollees especially considering your recognition of the use of obesity medications for their potential to aid weight loss, and improve glycemic and cardiovascular health indicators. 

It’s vitally important to adopt a holistic approach to tackling this chronic disease. Therefore, we would also like to discuss our request that CMS reopen the 2011 National Coverage Determination for Intensive Behavioral Therapy (IBT) for Obesity.1 Specifically, OCAN requests that CMS allow additional providers such as specialty physicians, nurse practitioners, clinical nurse specialists, and physician assistant (PAs), clinical psychologists, registered dietitians or nutrition professional, and Medicare Diabetes Prevention Programs to independently offer and bill for this service upon referral from their primary care provider without limitation to the primary care setting. This is included in the benefit category of additional preventive services. Additionally, providing for the virtual and/or telehealth provisions of these services would greatly improve access and utilization because the in the person requirement keeps many from utilizing it. 

We hope to meet with you soon to discuss both of these important issues as valuable tools in combating obesity. Please feel free to reach out to one of us, or our coordinator, Cristy Gallagher at cgallagher@obesitycareadvocacynetwork.com. 

Sincerely,

Catherine Ferguson 

OCAN Co-Chair 

Vice President, Federal Advocacy

American Diabetes Association 

cferguson@diabetes.org

Tracy Zvenyach, PhD, MS, RN 

OCAN Co-Chair 

Director, Policy Strategy & Alliance 

Obesity Action Coalition 

tzvenyach@obesityaction.org

Dorothea K. Vafiadis 

OCAN Co-Chair 

Senior Director, Center for Healthy Aging 

National Council on Aging 

Dorothea.Vafiadis@ncoa.org

1 Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for Intensive Behavioral Therapy for Obesity (210.12). 2011. Available at: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=353