States Consider Requiring Insurers to Cover Weight-Loss Drugs

On January 1, North Dakota became the first state in the U.S. to cover weight-loss drugs through the Affordable Care Act.

The expanded coverage is part of the state’s first update to its essential health benefit benchmark plan since the ACA was implemented in 2015. The change was made through a regulatory action by the state’s insurance department, which had been authorized to do so by state lawmakers in 2023.

Under the Peace Garden State’s update, individual health insurance plans compliant with the ACA now offer coverage for glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) drugs.

Those drugs, sold under name brands that include Ozempic, Wegovy, Mounjaro and Victoza, have been hyped as blockbuster treatments for weight loss, obesity and diabetes.

The Centers for Medicare & Medicaid Services has also approved changes to Virginia’s benchmark plan for 2025, as well as to Alaska’s and Washington’s for 2026 and Colorado’s for 2027. But there’s no mention of GLP-1 drugs in the documents for those updates on the CMS website.

Indeed, a representative of the North Dakota Insurance Department said in an email, “we’re not aware of any states actively seeking to add weight-loss drugs to their EHB.”

That doesn’t mean other states aren’t interested in seeing such weight-loss drugs covered by insurance, however. They’re just going about it in a different way.

A search of the LexisNexis® State Net® legislative database shows at least 13 states have introduced legislation dealing with coverage of GLP-1s by individual and group insurance plans or Medicaid this year. Those measures include:

• Arkansas HB 1332, by Rep. Aaron Pilkington (R), which would require the state’s Medicaid program to cover GLP-1 drugs when prescribed for weight loss.

• California AB 575, by Joaquin Arambula (D), which would require individual and group health care service plan contracts or health insurance policies that provide outpatient prescription drug benefits to include coverage for at least one anti-obesity medication.

• Connecticut HB 5038, by Rep. Christopher Rosario (D), which would include GLP-1 drugs in an expansion of a weight-loss program for state employees. In the same state, HB 5485, by Geoff Luxenberg (D), would establish a captive insurance company to administer a bulk purchase and distribution of GLP-1 drugs to qualifying individuals in the state.

• Iowa SSB 1138, by the Senate Health and Human Services Committee, which would require the state’s Department of Health and Human Services and its Department of Administration Services to review anti-obesity medications, including GLP-1 drugs, to see if they should be included in health insurance plans for public employees.

• Maine HB 395, by Rep. Holly Stover (D), which would require insurance coverage for GLP-1 drugs.

• Mississippi SB 2867, by Sen. Kevin Blackwell (R), which would provide coverage of GLP-1 drugs under Medicaid.

• Washington HB 1197, by Rep. Timm Ormsby (D), and its companion bill, SB 5166, by Sen. June Robinson (D), which are appropriations bills that would provide for a report on possible future coverage of GLP-1 drugs in the state’s uniform medical plan.

• West Virginia HB 2912, by Rep. Kayla Young (D), which would require insurance coverage of GLP-1 drugs provided to those with a valid script for those medications.

Over Dozen States Weighing Insurance Coverage of GLP-1 Drugs

Bills dealing with coverage of glucagon-like peptide-1 or GLP-1 weight-loss drugs by individual and group health insurance plans or Medicaid have been introduced this year in at least 13 states, according to the LexisNexis® State Net® legislative tracking system.

Source: LexisNexis State Net

Given the seemingly never-ending buzz around Ozempic and other weight-loss drugs, it’s probably a safe bet they’ll remain a hot topic for state policymakers for the rest of the year and beyond.

—By SNCJ Correspondent BRIAN JOSEPH

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