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House Co-Sponsorship Memoranda

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House of Representatives
Session of 2015 - 2016 Regular Session


Posted: February 17, 2016 12:32 PM
From: Representative Donna Oberlander
To: All House members
Subject: Payment for FDA approved anti-obesity drugs
In the near future I will be introducing legislation that will allow FDA approved anti-obesity drugs to be considered a compensable service under our State Medicaid Program.

In 2013, the American Medical Association (AMA) officially classified obesity as a disease. Obesity is associated with a number of chronic health issues, including but not limited to, diabetes, high blood pressure, cardiovascular disease and an increased risk of cancer; however, we currently do not provide access to specific tools available to treat obesity, as we do the above-mentioned conditions, namely pharmaceuticals. The AMA stated that “The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.” As such, it is critical for the health of all Pennsylvanians that we recognize this disease and provide access to the same medical therapies as we do other diseases.

Currently, any drug prescribed for obesity is considered a noncompensable service. Over the past few years, new medications have been approved by the U.S. Food and Drug Administration for chronic weight management. These drugs have been approved for adults with that meet specific criteria, including comorbidity with one or more other medical conditions (ex. high blood pressure, diabetes, heart disease, sleep apnea). To put this in perspective, in the 2013 Pennsylvania Diabetes Fact Sheet (based on 2010 data), provided by the Department of Health, between 899,000 and 999,000 adults age 18+ in Pennsylvania were estimated to have been diagnosed with diabetes. Further, diabetes and its complications were listed as the seventh leading cause of death. These numbers are expected to continue to grow, and so will the cost of treating these conditions. While the Commonwealth provides coverage for medications to treat the diabetes, we do not cover medications to treat those diabetic patients that are clinically obese.

According to an analysis conducted by the Robert Wood Johnson Foundation and the National Heart Forum, it was found that if Pennsylvania could reduce the BMI of its citizens by 5 percent, the state could help prevent thousands of cases of related conditions, while saving millions of dollars. When specifically looking at Type 2 Diabetes and using 2010 data, the analysis concluded that the potential cases avoided by 2020 if BMI was reduced by 5% (cumulative) was 185,919 and there was a potential savings of $3.208 billion.

I recognize that not every individual will be approved for the use of such medications, nor will those medications be successful for every patient; but I believe it’s imperative that all Pennsylvanians have access to them, just as they have access to medications to treat diabetes, high blood pressure, etc. I hope you will consider co-sponsoring, what I believe, is an important piece of legislation. Thank you.

Introduced as HB2088