Washington, D.C. – In a significant development, two health care bills championed by Rep. Brad Wenstrup have advanced through the House Ways and Means Committee. These bills aim to expand coverage for weight loss treatments for Medicare beneficiaries and increase access to breakthrough medical devices.
Expansion of Weight Loss Treatment Coverage
H.R. 4818, the Treat and Reduce Obesity Act, seeks to expand Medicare coverage for FDA-approved weight loss treatments. Currently, Medicare does not cover prescribed weight loss treatments for patients transitioning into Medicare. This legislation will bridge that gap, allowing patients to maintain coverage for their existing prescriptions. According to the Congressional Budget Office, this change will prevent an estimated 1.25 million patients from losing coverage over the next decade. The bill was favorably reported to the full House with a vote of 36-4. Rep. Wenstrup’s remarks on this issue can be viewed here.
Access to Breakthrough Medical Devices
H.R. 1691, the Ensuring Access to Critical Breakthrough Products Act, addresses the delays Medicare patients face in accessing FDA-approved breakthrough devices. The bill proposes four years of temporary Medicare coverage for such devices following FDA approval. It also mandates that Medicare make a permanent coverage determination within this four-year period. Currently, patients endure multi-year delays due to the lengthy coverage determination process by the Centers for Medicare & Medicaid Services (CMS). The bill aims to streamline this process, ensuring quicker access to these critical devices. The committee reported the bill to the full House with a vote of 36-5. Rep. Wenstrup’s full remarks on this issue can be viewed here.
Statements from Key Figures
“As a physician and lawmaker, I have worked to ensure patients can access critical health care treatments they need. The House Ways and Means Committee’s actions today to increase access to breakthrough medical devices and expand coverage of weight loss treatments for Medicare beneficiaries are a strong step towards that goal,” said Dr. Brad Wenstrup, D.P.M. “I look forward to a full House vote so we can continue to work to make America the healthiest nation on the planet.”
House Ways and Means Committee Chairman Jason Smith added, “With two out of three adults in the United States currently obese or overweight, Congress has a responsibility to remove inappropriate barriers to new medications that can help us fight back against the chronic disease epidemic in America that is linked to obesity. Thanks to Dr. Wenstrup’s leadership, this legislation will allow millions of seniors entering Medicare to maintain their treatment on anti-obesity medication, ensuring continuity of care and driving down their long-term health care costs.”
Regarding breakthrough devices, Smith noted, “The era of modern medicine has produced incredible devices that are helping patients achieve longer, healthier lives. Congressman Wenstrup’s bill will help streamline the coverage determination process for these devices to ensure patients can receive access quicker and through a more transparent, predictable, and efficient process.”
Background
Treat and Reduce Obesity Act:
- Provides Medicare Part D coverage of anti-obesity medications (AOMs) for individuals aging into Medicare who are currently treated by an AOM.
- Requires Medicare to re-evaluate its National Coverage Determination of Intensive Behavioral Therapy (IBT) to enhance treatment through diet and exercise.
- Mandates MedPAC to report on the coverage of AOMs in pre-Medicare markets to lay the groundwork for expanded coverage.
Ensuring Access to Critical Breakthrough Products Act:
- Tightens criteria for what breakthrough devices are eligible for coverage and removes unnecessary add-on payments.
- Requires all FDA-approved breakthrough devices to include clinical trial information relevant to the Medicare population.
- Grants CMS greater discretion in determining device eligibility for coverage.
- Allocates $10 million per year through 2030 for CMS to establish this new coverage pathway.
These advancements mark a crucial step toward improving health care access and outcomes for Medicare beneficiaries.
