HR 4231
Treat and Reduce Obesity Act of 2025
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Bill overview
The Treat and Reduce Obesity Act of 2025 aims to improve access to obesity treatment within Medicare. It expands coverage to allow intensive behavioral therapy to be provided by a broader range of healthcare professionals, including physicians who aren’t primary care doctors, physician assistants, and registered dietitians, as long as it’s coordinated with a primary care physician. Additionally, the bill allows Medicare Part D coverage for medications used to treat obesity or manage weight for overweight individuals with related health conditions.
Key provisions
- Expands Medicare coverage for intensive behavioral therapy for obesity.
- Allows coverage from a wider range of healthcare providers, including physician assistants and nurse practitioners.
- Requires referral and coordination with a physician or primary care practitioner for certain therapy types.
- Extends Medicare Part D coverage to include medications for obesity and weight loss management.
- Covers medications for overweight individuals with related comorbidities.
- Mandates a report to Congress on implementation efforts and recommendations for obesity prevention and treatment.
- Defines obesity and overweight for Medicare coverage purposes.
- Specifies settings where behavioral therapy must be provided (office, hospital, or community-based site).
Who is affected
- Medicare beneficiaries
- Healthcare providers (physicians, physician assistants, nurse practitioners, registered dietitians)
- Pharmaceutical companies
Sponsors
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Primary sponsor
Cosponsors
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119th CONGRESS — 1st Session
H. R. 4231
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes.
This Act may be cited as the Treat and Reduce Obesity Act of 2025
.
Congress makes the following findings:
According to the Centers for Disease Control and Prevention, about 41 percent of adults aged 60 and over had obesity in the period of 2015 through 2016, representing more than 27,000,000 people.
The National Institutes of Health has reported that obesity and overweight are now the second leading cause of death nationally, with an estimated 300,000 deaths a year attributed to the epidemic.
Obesity increases the risk for chronic diseases and conditions, including high blood pressure, heart disease, certain cancers, arthritis, mental illness, lipid disorders, sleep apnea, and type 2 diabetes.
Men and women with obesity at age 65 have decreased life expectancy of 1.6 years for men and 1.4 years for women.
On average, a Medicare beneficiary with obesity costs $2,018 (in 2019 dollars) more than a healthy-weight beneficiary.
The prevalence of obesity among older individuals in the United States is growing at a linear rate and, if nothing changes, nearly 1 in 2 (47 percent) Medicare beneficiaries aged 65 and over will have obesity in 2030, up from slightly more than 1 in 4 (28 percent) in 2010.
Section 1861(ddd) of the Social Security Act (42 U.S.C. 1395x(ddd)) is amended by adding at the end the following new paragraph:
Subject to subparagraph (B), the Secretary may, in addition to qualified primary care physicians and other primary care practitioners, cover intensive behavioral therapy for obesity furnished by any of the following:
A physician (as defined in subsection (r)(1)) who is not a qualified primary care physician.
Any other appropriate health care provider (including a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)), a clinical psychologist, a registered dietitian or nutrition professional (as defined in subsection (vv))).
An evidence-based, community-based lifestyle counseling program approved by the Secretary.
In the case of intensive behavioral therapy for obesity furnished by a provider described in clause (ii) or (iii) of subparagraph (A), the Secretary may only cover such therapy if such therapy is furnished—
upon referral from, and in coordination with, a physician or primary care practitioner operating in a primary care setting or any other setting specified by the Secretary; and
in an office setting, a hospital outpatient department, a community-based site that complies with the Federal regulations concerning the privacy of individually identifiable health information promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996, or another setting specified by the Secretary.
In order to ensure a collaborative effort, the coordination described in subparagraph (B)(i) shall include the health care provider or lifestyle counseling program communicating to the referring physician or primary care practitioner any recommendations or treatment plans made regarding the therapy.
Section 1860D–2(e)(2)(A) of the Social Security Act (42 U.S.C. 1395w–102(e)(2)(A)) is amended, in the first sentence—
by striking and other than
and inserting other than
; and
by inserting after benzodiazepines),
the following: and other than subparagraph (A) of such section if the drug is used for the treatment of obesity (as defined in section 1861(yy)(2)(C)) or for weight loss management for an individual who is overweight (as defined in section 1861(yy)(2)(F)(i)) and has 1 or more related comorbidities,
.
The amendments made by subsection (a) shall apply to plan years beginning on or after the date that is 2 years after the date of the enactment of this Act.
Not later than the date that is 1 year after the date of the enactment of this Act, and every 2 years thereafter, the Secretary of Health and Human Services shall submit a report to Congress describing the steps the Secretary has taken to implement the provisions of, and amendments made by, this Act. Such report shall also include recommendations for better coordination and leveraging of programs within the Department of Health and Human Services and other Federal agencies that relate in any way to supporting appropriate research and clinical care (such as any interactions between physicians and other health care providers and their patients) to treat, reduce, and prevent obesity in the adult population.