Peckkale

July 16, 2004 -- Health and Human Services secretary Tommy G. Thompson today announced that Medicare will begin covering obesity treatments as long as medical evidence shows they improve health.

"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely. Treating obesity-related illnesses and complications adds billions of dollars to the nation's health care costs," Thompson said during testimony before the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education.

"With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions."

This move is a sea change from previous Medicare policy, which stated that obesity is not an illness. Now, members of the public can request that Medicare review medical evidence to determine whether specific obesity treatments would be covered by Medicare.

By law, Medicare covers specified medically necessary services for illness and injury. The prior manual language, because it stated that obesity was not an illness, could prevent Medicare from covering treatments for diseases related to obesity.

"From the standpoint of Medicare coverage and the health of our beneficiaries, the question isn't whether obesity is a disease or a risk factor. What matters is whether there's scientific evidence that an obesity-related medical treatment improves health," Mark McClellan, MD, PhD, administrator for the Centers for Medicare & Medicaid Services (CMS).

"This change in Medicare's coverage policy puts the focus on public health. The medical science will now determine whether we provide coverage for the treatments that reduce complications and improve quality of life for the millions of Medicare beneficiaries who are obese."

The new policy is not expected to have an immediate impact on Medicare coverage. However, as requests for coverage of obesity treatments are made by the public, Medicare will review existing scientific evidence on the treatment. Essential to this process is published, clinical trial data that demonstrate that obesity-related treatments improve the health of Medicare beneficiaries.

"We encourage and we're expecting requests to review scientific evidence evaluating the benefits of a range of treatments for obesity in the Medicare population," said CMS Chief Medical Officer Sean Tunis, MD.

"As a first step, we expect to convene our Medicare coverage advisory committee in the fall to evaluate the evidence on obesity-related surgical procedures that may reduce the risk of heart disease and other illnesses."

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