ICYMI: Senator Carper Fights for American Patients to Lower Costs and Increase Access to Treatment

In Case You Missed It, U.S. Senator Tom Carper (D-Del.), a senior member of the Senate Finance Committee, introduced a slate of bipartisan legislation to lower costs for American families and bring patients back to the forefront of the medical system.

  • The PBM Oversight Act of 2023: bipartisan legislation that would provide much-needed oversight through a new CMS regulation into the ways PBMs determine which medications are included on the list of covered drugs under a person’s health plan.

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By: Joseph Choi

Sens. Tom Carper (D-Del.) and Chuck Grassley (R-Iowa) introduced legislation on Thursday aimed at providing the federal government with more power to oversee pharmacy benefit managers (PBM) amid continued bipartisan scrutiny over the companies’ role in drug pricing.

The two lawmakers introduced the PBM Oversight Act of 2023, which would give the Centers for Medicare and Medicaid Services (CMS) the authority to oversee PBM decision-making.

PBMs operate as middlemen within the pharmaceutical industry. These businesses negotiate with drug manufacturers for discounts and influence what drugs health insurance companies will cover. The drugs that a health insurance plan will cover are known as formularies.

The bill would also require that PBMs submit “detailed information” to CMS every year that includes documentation of their interactions with recommendation committees, groups who decide on what will be included on a formulary.

“By holding Pharmacy Benefit Managers accountable and establishing much-needed oversight of their practices, we will bring American patients back to the forefront of our medical system,” Carper said in a statement…


By: Gabrielle M. Etzel

Sens. Bill Cassidy (R-LA) and Tom Carper (D-DE), along with Reps. Brad Wenstrup (R-OH) and Raul Ruiz (D-CA), are introducing the Treat and Reduce Obesity Act, or TROA, in both chambers of Congress on Thursday, an effort to expand chronic obesity medication and treatment to Medicare recipients.

“…With obesity rates on the rise in our country, we must do more to combat this epidemic head-on,” Carper said. “Too many of those in need are being denied care because of the high cost of medications or inaccessible treatment options.”

TROA would extend coverage for intensive behavioral therapy to intensive behavioral therapy for treating obesity that can be administered either by a physician or by physician referral to a hospital or community-based counseling program.

The bill would also expand Medicare Part D coverage to include drugs such as Wegovy, which is prescribed on-label for weight loss, and Ozempic, which has grown in popularity in recent months as a weight loss drug.

Novo Nordisk, the maker of both Ozempic and Wegovy, hired a lobbying firm in May to push for the drugs to be included in Medicare coverage for the purposes of weight loss and obesity management. Ozempic is currently only covered by Medicare for Type 2 diabetes treatment, as per its Food and Drug Administration approval.

Carper has worked with multiple stakeholders since 2013 to expand obesity medicine coverage, including medication and behavioral treatments and preventive care…

“We cannot stand idly by while this disease continues to claim lives through related illnesses that are preventable and treatable,” Carper said. “I’m proud of our bipartisan and bicameral legislation to open the door for Medicare to provide Americans with every available treatment and tool for reducing obesity’s physical, social, and financial costs.”


By: Anjalee Khemlani

The recent surge in popularity of weight loss and Type 2 diabetes drugs Wegovy, Ozempic, and Mounjaro have been fueled by celebrity and influencer usage — but the success for the drugmakers has been a decade, and millions of lobbying dollars, in the making…

That bill is the Treat and Reduce Obesity Act (TROA), which has been introduced in every session of Congress since late 2012 by Sen. Thomas Carper, a Democrat from Delaware…

Carper, along with Sen. Bill Cassidy (R-La.) and Reps. Raul Ruiz (D-Calif.) and Brad Wenstrup (R-Ohio), reintroduced the bill for the seventh time since 2012 on Thursday.

The bill, among other things, directs Medicare Part D to cover obesity treatments if “used for the treatment of obesity … or for weight loss management for an individual who is overweight … and has one or more related co-morbidities…”


By: Shelby Livingston

… But US lawmakers on Thursday took steps to broaden access to weight-loss treatment for seniors. They introduced a bill, titled The Treat and Reduce Obesity Act of 2023, in the Senate and House of Representatives that would allow Medicare to pay for weight-loss drugs for the first time.

Previous versions of the bill have languished in Congress for more than a decade. This time, though, the proposal is being reintroduced amid an avalanche of demand for new and effective weight-loss drugs and a lobbying blitz by the drugmakers behind them.

Should the legislation become law, the implications could extend beyond seniors. Medicare coverage might prod other health insurers to pay for weight-loss medications, as private health plans tend to follow Medicare’s lead. About 65 million people are enrolled in Medicare, while more than 150 million people get health coverage from an employer.

“With obesity rates on the rise in our country, we must do more to combat this epidemic head on. Too many of those in need are being denied care because of the high cost of medications or inaccessible treatment options,” Democratic Sen. Tom Carper said in a press release.

Carper reintroduced the bill along with Republican Sen. Bill Cassidy and Representatives Raul Ruiz, a California Democrat, and Brad Wenstrup, a Republican from Ohio…