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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10272 Introduced in House (IH)]

<DOC>

118th CONGRESS
  2d Session
                               H. R. 10272

To amend title XVIII of the Social Security Act to provide coverage of 
weight loss agents for certain individuals under part D of the Medicare 
                                program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            December 3, 2024

 Mrs. Cherfilus-McCormick (for herself and Mr. Kelly of Pennsylvania) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To amend title XVIII of the Social Security Act to provide coverage of 
weight loss agents for certain individuals under part D of the Medicare 
                                program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Dual Eligible Americans Living with 
Obesity Act of 2024'' or the ``DEAL with Obesity Act of 2024''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to the Kaiser Family Foundation, 12.5 million 
        people are dually enrolled in both Medicare and Medicaid.
            (2) Dual Eligible beneficiaries overwhelmingly possess 
        limited financial resources, with 87 percent having an income 
        of less than $20,000 annually.
            (3) A one month's supply of a GLP-1 receptor agonist, on 
        average, costs between $900 and $1,350.
            (4) Coverage of GLP-1 medications can lower out-of-pocket 
        monthly costs to as little as $25 per month, according to a 
        study published in JAMA.
            (5) Data from the Centers for Medicare and Medicaid show 
        that 38 percent of Medicaid beneficiaries and 48 percent of 
        Medicare beneficiaries are affected by obesity.
            (6) Obesity is the second leading cause of death in the 
        U.S., leading to 300,000 deaths per year, according to the 
        National Institutes of Health.
            (7) Adults in the U.S. living with obesity experience 
        higher annual out-of-pocket medical costs of $2,505, on 
        average, compared to those with normal weight.
            (8) Obesity in the U.S. costs the healthcare system $173 
        billion annually and is projected to cost the U.S. $550 billion 
        annually by 2030.

SEC. 3. PROVIDING COVERAGE OF WEIGHT LOSS AGENTS FOR CERTAIN 
              INDIVIDUALS UNDER PART D OF THE MEDICARE PROGRAM.

    Section 1860D-2(e) of the Social Security Act (42 U.S.C. 1395w-
102(e)) is amended--
            (1) in paragraph (2)(A), in the first sentence--
                    (A) by striking ``and other than'' and inserting 
                ``other than''; and
                    (B) by inserting ``and, with respect to plan years 
                beginning on or after January 1, 2026, other than 
                subparagraph (A) of such section if the drug is 
                approved under section 505 of the Federal Food, Drug, 
                and Cosmetic Act or licensed under section 351 of 
                Public Health Service Act for long-term weight 
                reduction in individuals with obesity (as defined in 
                section 1861(yy)(2)(C)) or who are overweight (as 
                defined in section 1861(yy)(2)(F)(i)) and is used for 
                the treatment of obesity for a specified individual (as 
                defined in paragraph (5)) or for weight loss management 
                for such an individual who is overweight,'' after 
                ``benzodiazepines),''; and
            (2) by adding at the end the following new paragraph:
            ``(5) Specified individual defined.--For purposes of 
        paragraph (2)(A), the term `specified individual' means an 
        individual who is eligible for medical assistance under a State 
        plan under title XIX (or under a wavier of such plan).''.
                                 <all>
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