This bill mandates that health plans in the state provide coverage for glucagon-like peptide-1 (GLP-1) medications under specific conditions. The new section 420-J:6-f of the Managed Care Law stipulates that health carriers must cover GLP-1 medications if the covered person's body mass index (BMI) is equal to or greater than 40, or if the BMI is equal to or greater than 35 and the individual has one or more specified co-morbidities, including Type 2 diabetes, hypertension, coronary artery disease, sleep apnea, high cholesterol, or severe osteoarthritis. This provision expands the eligibility criteria for GLP-1 medications beyond the current commercial coverage model, which aligns closely with Medicare's standards.

The bill is expected to have an indeterminable fiscal impact on state and local revenues and expenditures, as it may lead to an increase in claims for GLP-1 medications, potentially resulting in higher overall premiums. The Insurance Department notes that while the exact financial implications cannot be precisely estimated without further analysis, there is a possibility of increased expenditures ranging from $100 to $200 million due to the expanded eligibility. The bill is set to take effect 60 days after its passage and does not apply to self-funded health benefit plans, such as the State Employee Health Benefit Plan.