CMS' strategy is missing the mark: how a focus on prevention can improve health outcomes and contain costs

An Expert View from Cynthia Miller, vice president, medical director of the access experience team, PRECISIONvalue.

US President Joe Biden recently announced the first 10 drugs that Centers for Medicare & Medicaid Services (CMS) identified for price negotiations starting in 2025. Drug costs and risk of Medicare insolvency concern many stakeholders, however, the Inflation Reduction Act and additional proposed policies in congress may not be the solution on its own. While the CMS has continuously updated their focus to meet the needs of Americans, there is more to be done to address the changing dynamics of the Medicare population. As Americans begin to live longer, the CMS may need to focus more on prevention, not just disease treatment, to deliver quality outcomes at manageable costs.

Historically, the medical community considered obesity a lifestyle condition, a designation that has limited patient access to treatment. However, a recent slew of medications has shown promising weight loss and even  cardiovascular benefit secondary to that weight loss. Multiple drugs  headlined at the 2023 American Diabetes Association (ADA) Meeting highlight the expanding field. As Robert Gabbay, the ADA’s chief scientific and medical officer noted, “all of those studies really had impressive results, and it suggests that before long we’re going to have a number of new options for the treatment of obesity.” A 2003 Part D provision restricts the CMS from covering medications “when used for anorexia, weight loss, or weight gain.” Lawmakers have proposed a bipartisan bill called The Treat and Reduce Obesity Act. However, this bill has been repeatedly brought to the house and senate since 2013 and has yet to be passed.