OCC Advocacy Report | November 2022

MID-TERM ELECTIONS: Democrats Maintain Senate Control while GOP Flips Control of the House

At the time of this report, Republicans have won enough seats to command a slim majority and take control of the House of Representatives next year when the 118th Congress convenes in January. On the Senate side, Democrats maintained control of the chamber — securing 50 seats with the possibility of reaching 51 should current Georgia Senator Raphael Warnock defeat his Republican challenger Herschel Walker in a special December 6th run-off election.

Prospects for Passage of TROA Fading Fast

As the 117th Congress enters the final weeks of its lame duck session, the odds of passing the Treat and Reduce Obesity Act (TROA) remain very remote given the inability to achieve a formal budget score from the Congressional Budget Office and the heavy workload still facing legislators before Congress closes up shop at the end of December. As a result, obesity advocates are now looking to 2023 and the 118th Congress for possible reintroduction of TROA.

2023 will mark the 11th straight year that TROA has been under congressional consideration — both under democratic and republican controlled houses of Congress. No matter which party controls the House or the Senate, TROA has continuously enjoyed strong support with more than 175 members of Congress supporting the legislation in each of the last three Congresses — with both republicans and democrats taking leadership roles.

While Committee and Subcommittee Chair assignments have not been formally announced by Republicans in the House, it is very likely that Representative Cathy McMorris-Rodgers (R-WA) will chair the House Energy & Commerce Committee and Representative Brett Guthrie (R-KY) will lead the E&C Health Subcommittee. This could be very beneficial given that McMorris-Rodgers is a past cosponsor of TROA and Guthrie was the House Republican champion for TROA during the 116th Congress.

However, as with any new Congress, many supporters of TROA will be lost due to retirement, resignation, death or losing reelection. For example, long-time House democratic TROA champion Representative Ron Kind (D-WI) will be retiring this year. In addition, 37 other House TROA cosponsors will not be returning in the 118th Congress — a loss of nearly 25 percent of supporters. On the positive side, Senate TROA champion Tom Carper (D-DE) and all 22 Senate cosponsors will be back next year! Stay tuned for more updates on policy strategy for the coming new Congress.

Final ICER Report Includes Promising Recommendations for Obesity Care

On October 20th, the Institute for Clinical and Economic Review (ICER) released its final policy recommendations surrounding treatments for obesity management — specifically evaluating the cost-effectiveness of anti-obesity medications (AOMs). The October report reflects the culmination of roughly seven months of evidence development and public stakeholder engagement by ICER, including a special policy roundtable on September 16th that included obesity advocates Joe Nadglowski, Nikki Massie and Drs. Lee Kaplan and Scott Kahan.

In releasing their policy recommendations, ICER’s Chief Medical Officer, David Rind, MD stated that “The vast majority of people with obesity cannot achieve sustained weight loss through diet and exercise alone. As such, obesity, and its resulting physical health, mental health, and social burdens is not a choice or failing, but a medical condition. The development of safe and effective medications for the treatment of obesity has long been a goal of medical research that now appears to be coming to fruition. With a condition affecting more than 40% of adults in the US, the focus should be on assuring that these medications are priced in alignment with their benefits so that they are accessible and affordable across
US society.”

In terms of recommendations, the following bullet points summarize the policy priorities from
ICER:

• All stakeholders have an important role to play in ensuring that people living with obesity have access to effective medications as a core benefit of health care insurance coverage.
• Manufacturers should set the price for new treatments for obesity in proportion to their demonstrated benefit to patients and society, with adjustments for residual uncertainty about long-term benefits and the large size of the potential population of people to be treated. Similarly, payers should ensure that pharmaceutical benefit designs developed in conjunction with employers and other plan sponsors ensure access to approved therapies among individuals with obesity.
• All stakeholders should take steps that make effective treatment options for people living with obesity available in a way that will help reduce health inequities.
• Manufacturers should develop patient assistance programs at a level commensurate with other chronic disease conditions to support access to medications among racial and ethnic groups where the burden of obesity is increased, payer coverage is low, and inability to afford out-of-pocket payments is common. Likewise, payers should design coverage criteria that are sensitive to racial and ethnic variability in the clinical applicability of BMI thresholds.

AMA to Take Leadership Role in Addressing Obesity

During the American Medical Association (AMA) House of Delegates’ (HOD) Interim Meeting this November, the AMA’s Board of Trustees announced new policy —stating that AMA “will: (a) assume a leadership role in collaborating with other interested organizations, including national medical specialty societies, the American Public Health Association, the Center for Science in the Public Interest, and the AMA Alliance, to discuss ways to finance a comprehensive national program for the study, prevention, and treatment of obesity, as well as public health and medical programs that serve vulnerable populations; (b) encourage state medical societies to collaborate with interested state and local organizations to discuss ways to finance a comprehensive program for the study, prevention, and treatment of obesity, as well as public health and medical programs that serve vulnerable populations; and (c) continue to monitor and support state and national policies and regulations that encourage
healthy lifestyles and promote obesity prevention.”

The move by AMA comes as a result of policy advanced by the Obesity Caucus, which was founded under the leadership of OMA Past-President Dr. Ethan Lazarus. In addition to the above, AMA will also “leverage existing channels within AMA that could advance the following priorities:

• Promotion of awareness amongst practicing physicians and trainees that obesity is a treatable chronic disease along with evidence-based treatment options.
• Advocacy efforts at the state and federal level to impact the disease obesity.
• Health disparities, stigma and bias affecting people with obesity.
• Lack of insurance coverage for evidence-based treatments including intensive lifestyle intervention, anti-obesity pharmacotherapy and bariatric and metabolic surgery.
• Increasing obesity rates in children, adolescents and adults.
• Drivers of obesity including lack of healthful food choices, over-exposure to obesogenic foods and food marketing practices.”

Finally, AMA “will conduct a landscape assessment that includes national level obesity prevention and treatment initiatives, and medical education at all levels of training to identify gaps and opportunities where AMA could demonstrate increased impact.”