Committee Hears Two Bills to Require GLP‑1 Coverage for Public Plans; Fiscal and Clinical Concerns Raised

Chairman Ruby reopened hearings on House Bill 1451 and House Bill 1452 during the House Human Services Committee on Feb. 15; both bills would require coverage of GLP‑1 class medications for chronic weight management under state public plans.

Lacey Anderson, representing Novo Nordisk, told the committee that HB 1451 would add GLP‑1 coverage to Medicaid expansion and HB 1452 would cover the same drugs for public employees through the Public Employees Retirement System (PERS) plan for a two‑year period. "14 51 is the coverage under Medicaid... This would try to help people initially before they get to that point where things are covered to then ease health care costs long term," Anderson said, describing the bills' intent to prevent severe obesity and related procedures.

Anderson described an amendment offered by Representative Nelson that raises the BMI threshold in the bills to the level for class‑2 obesity (BMI 35–39.9) and removes language requiring state coverage criteria to match any future FDA changes. "The amendment... increases the BMI requirement to... level 2 obesity," she said.

Representatives and witnesses asked clinical and coverage questions. Representative Kiefer asked what a BMI "equal to or greater than 35 kilograms per square meter" means; Anderson replied it corresponds to a BMI of 35–39.9. On maintenance dosing, Anderson said treatment length and frequency would be “dependent on the physician's determination” and could vary greatly by patient.

From the insurance side, Dylan Wheeler of Sanford Health Plan opposed coverage mandates, saying they raise premiums and reduce plans' flexibility. "We do oppose coverage mandates," Wheeler said, adding that GLP‑1 drugs are a "volatile, costly, and highly utilized" prescription category and that requiring coverage and prominent notification to members would increase costs. Wheeler cited a North Carolina example where a public plan began covering weight‑loss medications and later ceased coverage because of high cost and utilization.

Derek Holbein, chief operating and financial officer for PERS, testified in a neutral capacity on fiscal impacts for HB 1452. Using an illustrative drug cost of $2,425 per month, Holbein walked the committee through the PERS prescription benefit structure and how the plan's coinsurance and copay rules would translate into plan‑paid amounts. He said the current fiscal note estimates large costs and that PERS has approximately $55 million in reserves versus an unfunded estimate of roughly $72 million if the bill passed as written. "If the bill were to pass as is and it's gonna cost $72,000,000... this will bankrupt the reserves that PERS has on hand," Holbein warned.

Committee members pressed about whether coverage would reduce future medical costs. Supporters said long‑term savings are a goal, but both Wheeler and Holbein said short‑term drug spending is likely to be high and any medical savings would accrue over many years. Holbein noted the actuary (Deloitte) had not analyzed the amendment and that revised fiscal notes would be produced if the committee adopted changes that narrow eligibility.

No votes were taken on HB 1451 or HB 1452 during the hearing; both hearings were closed for the day and the committee moved on to other bill work. Committee members requested revised fiscal analyses if amendments narrowing eligibility were adopted and flagged uncertainties about long‑term clinical benefits, patent timelines and advertising‑driven utilization.

The record includes written testimony submitted for the bills and multiple committee questions about maintenance dosing, FDA indications and the interaction with existing coverage for diabetes.