H.R. 4231 — Treat and Reduce Obesity Act of 2025

This section states congressional findings on obesity prevalence among adults aged 60 and older (41% in 2015-2016, or over 27 million people), its role as the second leading cause of death (over 300,000 annually), health risks (e.g., heart disease, type 2 diabetes), Medicare impacts (over half of beneficiaries treated for 5+ chronic conditions yearly; obesity rate doubled from 1987 to 2002 and nearly doubled again by 2016; $50 billion spent on obese beneficiaries in 2014; average obese beneficiary costs $2,018 more than healthy-weight in 2019 dollars), reduced life expectancy at age 65 (1.6 years for men, 1.4 for women), total costs (over $427.8 billion in 2014), and projected Medicare beneficiary obesity rate of 47% by 2030 (from 28% in 2010).

This section authorizes the Secretary to expand Medicare coverage of intensive behavioral therapy for obesity—currently limited to qualified primary care physicians and other primary care practitioners—to include (1) other physicians; (2) other appropriate health care providers (e.g., physician assistants, nurse practitioners, clinical nurse specialists, clinical psychologists, or registered dietitians or nutrition professionals); and (3) Secretary-approved evidence-based community-based lifestyle counseling programs. For providers under (2) and (3), coverage requires referral from and coordination with a physician or primary care practitioner (including communication of recommendations or treatment plans back to the referring provider) and furnishing in an office setting, hospital outpatient department, HIPAA-compliant community-based site, or other Secretary-specified setting.

This section revises the definition of covered Part D drugs to require coverage of drugs used for the treatment of obesity (as defined in SSA §1861(yy)(2)(C)) or for weight loss management for overweight individuals (as defined in SSA §1861(yy)(2)(F)(i)) with one or more related comorbidities, effective for plan years beginning two years after enactment. (As background, current law excludes from Medicare Part D coverage—i.e., the Medicare prescription drug benefit—drugs used for anorexia, weight loss, or weight gain.)

This section directs the Secretary of Health and Human Services to submit to Congress, not later than one year after enactment of this Act and every two years thereafter, a report describing steps taken to implement this Act and its amendments. The report must also include recommendations for better coordination and leveraging of programs within the Department of Health and Human Services and other federal agencies that support research and clinical care (e.g., physician-patient interactions) to treat, reduce, and prevent obesity in adults.